Abstract
Background/Objectives: Heart disease (HD) is recently becoming the foremost cause of death worldwide, underlining the importance of early and correct diagnosis to improve patient outcomes. Although Internet of Things (IoT)-enabled machine learning approaches have demonstrated encouraging outcomes in screening, existing approaches often face challenges such as imbalanced dataset handling, influential feature selection identification, and the ability to adapt to evolving HD data forms. To tackle the aforementioned challenges, we present a sequential hybrid approach, RAVE-HD (ResNet And Vanilla RNN Ensemble for HD), that combines a number of cutting-edge techniques to enhance screening. Methods: Preprocessing phase includes duplicates removal and feature scaling for data consistency. Recursive Feature Elimination is employed to extract the most informative features, while a proximity-weighted random synthetic sampling technique addresses class imbalance to reduce class biases. The proposed RAVE model in RAVE-HD approach sequentially integrates a Residual Network (ResNet) for high-level feature extraction and Vanilla Recurrent Neural Network to capture the non-linearity of the feature relationships present in the HDHI medical dataset. Results: Compared to ResNet and Vanilla RNN baselines, the proposed RAVE model attained superior results: 92.06% accuracy and 97.12% ROC-AUC. Stratified 10-fold cross-validation validated the robustness of RAVE, while Sensitivity-to-Prevalence analysis demonstrated stable recall and predictable precision across varying disease prevalence levels. Additional evaluations, including bootstrap and DeLong analyses, showed statistical significance (p<0.001) of the discriminative gains of RAVE. Minimum Clinically Important Difference (MCID) evaluation confirmed clinically meaningful improvements (≥3%) over strong baselines. Cross-dataset validation using the CVD dataset verified robust generalization (92.4% accuracy). SHAP analysis provided interpretability to build clinical trust. Conclusions: RAVE-HD shows promise as a reliable, explainable, and scalable solution for large-scale HD screening, consistently performing well across diverse evaluations and datasets. Through statistical validation, the RAVE-HD approach emerges as a practical decision-support tool in HD predictive screening results.