.. _background: Clinical Background =================== Introduction ------------ Cardiovascular disease (CVD) is the most common cause of death both in Europe and globally, and ischaemic heart disease accounts for almost 50\% of CVD deaths (`Townsend et al. `_). Globally, over 1 in 50 potential years of life are either lost to death or lived with disability due to ischemic heart disease (`Mensah et al. `_). In ischaemic heart disease, the blood flow and supply of oxygen to the heart is reduced. The most severe form is myocardial infarction (MI), also known as a heart attack, where part of the heart tissue dies due to insufficient blood flow. MI represents an important health burden, accounting for approximately 9 million deaths globally each year (`Vaduganathan et al. `_). In the UK, MI accounted for 18,865 deaths in 2023 (3\% of all deaths, from census data), and typically accounts for 100,000 hospital admissions per year (`Hall et al. `_). The risk of death after MI varies greatly between patients. Some patients require immediate invasive treatment to identify blocked arteries, open up these arteries, and restore blood flow to the heart muscle. However, invasive surgical procedures carry risks as well as benefits, such as major bleeding (`Galli et al. `_). Risk assessment tools are used to guide decision-making about what treatments to offer to each patient. Current risk assessment approaches used in clinical practice (such as the GRACE score) involve calculating a score from routine clinical data collected from MI patients at presentation. Many approaches have been proposed to enhance risk assessment models with additional variables such as left ventricular ejection fraction (LVEF) measured via echocardiography, and ECG characteristics extracted from 12-lead or continuous ECG signals. These approaches could potentially help inform decision-making. This toolbox was designed to investigate associations between ECG features and health outcomes in patients who had suffered an MI.