Explainable machine learning for early heart disease risk prediction: Insights from a clinical dataset in Bangladesh

Cardiovascular diseases remain one of the leading causes of mortality worldwide, particularly in low- and middle-income countries. Early and accurate prediction of heart disease is essential for timely intervention and improved patient outcomes. Machine learning techniques offer promising solutions; however, challenges such as class imbalance, lack of interpretability, and limited real-world validation persist. In this study, a machine learning–based heart disease prediction framework was developed using a real-world clinical dataset comprising 5000 patient records collected from healthcare facilities in Bangladesh. Data preprocessing included cleaning, feature encoding, train–test splitting, and class imbalance handling using the Synthetic Minority Oversampling Technique (SMOTE). Multiple machine learning models—Logistic Regression, Decision Tree, Support Vector Machine, and Random Forest—were evaluated using 10-fold stratified cross-validation. Model performance was assessed using accuracy, precision, recall, and F1-score. SHAP (SHapley Additive exPlanations) was employed to enhance model interpretability. The best-performing model was deployed as a web-based decision support system. Among the evaluated models, the Random Forest classifier achieved the best performance, with an accuracy of 98%, recall of 96%, and F1-score of 96%. Ablation studies demonstrated the effectiveness of SMOTE, feature integration, and ensemble modeling. SHAP analysis identified clinically relevant features contributing to heart disease prediction, enhancing transparency and trust in model decisions. The proposed framework provides an accurate, interpretable, and practical solution for heart disease prediction using real-world clinical data. The integration of explainable machine learning and web-based deployment highlights its potential for clinical decision support. Future work will focus on multi-center prospective validation and adaptive model updating to further improve generalizability and real-world applicability. • A large real-world clinical dataset of 5000 patients was used for robust heart disease prediction. • A Random Forest model with SMOTE achieved high performance (98% accuracy, 96% recall). • Comprehensive ablation and model comparison analyses validate methodological robustness. • SHAP-based explainability provides transparent and clinically interpretable predictions. • The proposed system is deployed as a web-based clinical decision support tool.