AUTHOR=Ashika T. , Hannah Grace G. TITLE=Enhancing heart disease prediction with stacked ensemble and MCDM-based ranking: an optimized RST-ML approach JOURNAL=Frontiers in Digital Health VOLUME=Volume 7 - 2025 YEAR=2025 URL=https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2025.1609308 DOI=10.3389/fdgth.2025.1609308 ISSN=2673-253X ABSTRACT=IntroductionCardiovascular disease (CVD) is a leading global cause of death, necessitating the development of accurate diagnostic models. This study presents an Optimized Rough Set Theory-Machine Learning (RST-ML) framework that integrates Multi-Criteria Decision-Making (MCDM) for effective heart disease (HD) prediction. By utilizing RST for feature selection, the framework minimizes dimensionality while retaining essential information.MethodsThe framework employs RST to select relevant features, followed by the integration of nine ML classifiers into five stacked ensemble models through correlation analysis to enhance predictive accuracy and reduce overfitting. The Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) ranks the models, with weights assigned using the Mean Rank Error Correction (MEREC) method. Hyperparameter tuning for the top model, Stack-4, was conducted using GridSearchCV, identifying XGBoost (XG) as the most effective classifier. To assess scalability and generalization, the framework was evaluated using additional datasets, including chronic kidney disease (CKD), obesity levels, and breast cancer. Explainable AI (XAI) techniques were also applied to clarify feature importance and decision-making processes.ResultsStack-4 emerged as the highest-performing model, with XGBoost achieving the best predictive accuracy. The application of XAI techniques provided insights into the model's decision-making, highlighting key features influencing predictions.DiscussionThe findings demonstrate the effectiveness of the RST-ML framework in improving HD prediction accuracy. The successful application to diverse datasets indicates strong scalability and generalization potential, making the framework a robust and scalable solution for timely diagnosis across various health conditions.