Enhancing Framingham Cardiovascular Risk Score Transparency through Logic-Based XAI

Abstract: Cardiovascular disease (CVD) remains one of the leading global health challenges, accounting for more than 19 million deaths worldwide. To address this, several tools that aim to predict CVD risk and support clinical decision making have been developed. In particular, the Framingham Risk Score (FRS) is one of the most widely used and recommended worldwide. However, it does not explain why a patient was assigned to a particular risk category nor how it can be reduced. Due to this lack of transparency, we present a logical explainer for the FRS. Based on first-order logic and explainable artificial intelligence (XAI) fundaments, the explainer is capable of identifying a minimal set of patient attributes that are sufficient to explain a given risk classification. Our explainer also produces actionable scenarios that illustrate which modifiable variables would reduce a patient's risk category. We evaluated all possible input combinations of the FRS (over 22,000 samples) and tested them with our explainer, successfully identifying important risk factors and suggesting focused interventions for each case. The results may improve clinician trust and facilitate a wider implementation of CVD risk assessment by converting opaque scores into transparent and prescriptive insights, particularly in areas with restricted access to specialists.