Nurse-Led Large Language Model Chatbot for Predicting and Preventing Complications After Coronary Artery Bypass Grafting: Protocol for a Randomized Controlled Trial

作者：K S, K L A, Kerala Varma P, B P, K P A, Agnihotri V, Muthu P, Bhaskaran R, Nair N · 发表于：JMIR research protocols · 年份：2026 · DOI：10.2196/103717 · 被引用次数：57 · 研究领域：artificial intelligence、coronary artery bypass grafting、electrocardiographic monitoring、hospital readmission、large language model、postoperative care、postoperative complications、randomized controlled trial、remote patient monitoring、thirty-day hospital readmission

BACKGROUND: Thirty-day unplanned readmission following coronary artery bypass grafting (CABG) affects 10%-20% of patients and is a key quality indicator, particularly in low- and middle-income countries (LMICs) where access to cardiac rehabilitation is limited. Existing risk models are static, lack real-time engagement, and no validated large language model (LLM)-based clinical decision support (CDS) system exists for post-CABG readmission prevention. OBJECTIVE: This protocol describes the development, validation, and evaluation of Smart CABGuard, a nurse-led, LLM-based CDS chatbot with continuous remote electrocardiographic (ECG) monitoring, to predict and prevent postoperative complications, and 30-day unplanned readmission after isolated CABG. METHODS: This multiphase translational study is conducted at Amrita Institute of Medical Sciences, Kochi, India, following TRIPOD-LLM (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis-Large Language Model) and CONSORT (Consolidated Standards of Reporting Trials) AI reporting guidelines. Phase I uses an ambispective design (retrospective: January 2020 to December 2024; prospective needs survey: June 2025 to January 2026) to develop a logistic regression-based Complication Risk Index (CRI), assessed via receiver operating characteristic area under the curve, Brier score, and decision curve analysis. Phase II refines Smart CABGuard by integrating a frozen Mistral-7B LLM (low-rank adaptati...