Cardiovascular Risk Assessment Using Intuitionistic

Fuzzy Logic System

1st Sarfaraj Mirza
Dept.of Instrumentation and Control
College of Engineering, Pune
Pune, India
mirzasm18.instru@coep.ac.in
2nd Trupti Gujarathi
Dept.of Instrumentation and Control
College of Engineering, Pune
Pune, India
gujarathitp17.instru@coep.ac.in
3rd kalyani Bhole
Dept.of Instrumentation and Control
College of Engineering, Pune
Pune, India
kab.instru@coep.ac.in

Abstract—For complex, ill-defined problems, where the un-
certainty lies, fuzzy logic is the best suitable methodology to
work with. We can achieve a certain level of accuracy and
precision by accepting uncertainty. An Intuitionistic fuzzy logic
represents imperfect knowledge that lies while dealing with real-
life problems. For example, in decision making human opinion
has two or more answers such as ”may not be”, ”might be”
etc. In such a case human opinion is not firm or has some
hesitancy in decision making. An intuitionistic fuzzy logic system
can deal with this hesitancy and uncertainty that appears in the
real world problems. This paper reviews on intuitionistic fuzzy
set, its operations, intuitionistic fuzzy logic system and different
applications with a case study in healthcare diagnosis.
Index Terms—Fuzzy Logic, Fuzzy Set, Intuitionistic Fuzzy
Set(IFS), Intuitionistic Fuzzy Inference System (IFIS), Hesitant
membership function(HMF), Non-membership function(NMF),
Medical diagnosis
I. I NTRODUCTION
The hypothesis of fuzzy logic gives a scientific way to
deal with hesitancy related with reasoning and thinking. [1]
[2]. Hesitancy or uncertainty shows up in various structures
and influences choices making. As often as possible, data
might be inadequate, loose, fragmentary, not completely solid,
ambiguous, or insufficient in some other way. [6]. Intuitionistic
fuzzy sets (IFSs) [3] [4] [5], proposed as a generalization of
the traditional fuzzy sets introduced by Zadeh [1], which has
the property to compute the uncertainty of the information.
Intuitionistic fuzzy sets was introduced by Atanassov in 1983
[3]. The concept of intuitionistic fuzzy set extends a fuzzy
set by having an additional hesitancy parameter besides the
usual membership function. An Intuitionistic fuzzy set handle
more uncertainty than type-1 fuzzy set [1] and type-2 fuzzy
set.The authors have also worked earlier on interval type-2
fuzzy logic based decision support system [14],in which we
found that expert knowledge also contains hesitancy which
overcome by IFLS. Intuitionistic fuzzy sets based models
might be sufficient in circumstances when we face human
declarations, suppositions, and so forth including (at least two)
answers of the sort: Yes, No,May not be sure, I don’t have idea,
, and so on [11].
Atanassov (1983) introduced the concept of Intuitionistic
Fuzzy sets (IFS). The same time a theory called ’Intuitionistic
Fuzzy set theory’ was independently introduced by Takeuti and
Titani(1984) as a theory developed in (a kind of) Intuitionistic
logic [3] [4] [5]. Atanassov (1994) carried out rigorous re-
searches based on the theory and applications of intuitionistic
fuzzy sets [5]. Atanassov et. al. (1995) have widely applied
the theory of an intuitionistic sets in logic programming.
Therefore, in various applications of engineering, intuitionistic
fuzzy set techniques have become more popular than fuzzy
set techniques in recent years. Szmidt and Kacprzyk (1996)
illustrated the IFSs on a voting model where ”yes”, ”no”
and ”abstain” votes are possible [10]. Szmidt and Kacprzyk
(2001) exhibited intuitionistic fuzzy sets as an instrument
for thinking within the sight of imperfect knowledge and
uncertainty. [11]. De et al (2001) gave an intuitionistic fuzzy
sets approach in medical diagnosis in which formulation of
medical knowledge, assurance of side effects dependent on
intuitionistic fuzzy relations, and diagnosis based on creation
of intuitionistic fuzzy relations. Supriya Kumar et al (2001)
studied of Sanchez (1979) approach for medical diagnosis
made with a generalized notion of IFS theory [12]. Ahn et al
(2011) proposed a another methodology for medical diagnosis
using the distance between interval-valued IFS. On the other
hand, De et al (2001) and Ahn et al (2008) applied the max-
min composition to diagnose the condition of the patients.
Edward and Balamurugan (2012a) proposed a new technique
named intuitionistic fuzzy max–min composition to study the
Sanchez’s approach. In the same year Edward and Balamuru-
gan (2012b) proposed a new technique to medical diagnose
the symptom of the disease using IFS with logical operators
[15]. Edward and Balamurugan (2013a) introduced IFS with
n-Parameters in Medical Diagnosis. In the same year Edward
and Balamurugan (2013b) also proposed intuitionistic fuzzy
set with ordering method for medical diagnosis [16]. Geetha-
lakshmi et al (2012a) introduced a new technique named fuzzy
max-min composition to study Sanchez’s approach for the
analysis of health problems faced by IT workers with the help
of intuitionistic fuzzy sets. In the same year Geethalakshmi et
al (2013b) analyzed the problems of students that affect their
studies with the help of Intuitionistic fuzzy sets [22]. Ejegwa
et al (2014a) proposed the application of intuitionistic fuzzy
sets(IFS) in a career determination [20].
In this sequel, this paper proposes a review on intuitionistic
fuzzy logic system for medical diagnosis. This paper com-
prises of five sections: Section II describes basic concept of
Intuitionistic fuzzy set; section III describes procedure to de-
sign intuitionistic fuzzy inference system and representation of
different types of membership and non-membership functions;
section IV describes general applications of IFLS; section
V describes case study(cardiavascular disease diagnosis); and
Section V offers conclusion based on the results and discus-
sions.

II. I NTUTIONISTIC F UZZY S ET

An Intuitionistic Fuzzy set A in X is defined as,

A = {(x, µA (x) , vA (x))} (∀x ∈ X) (1) Fig. 1. IFLS Block Diagram

The numbers µA (x) and vA (x) denote the degree of member-

ship and non-membership of X to A, respectively. Obviously, A. Membership and Non-membership Function
a fuzzy set A corresponds to the following intuitionistic fuzzy General representation of an Intuitionistic fuzzy set, also
set for each intuitionistic fuzzy set A in X, there are different types of graphical representation of mem-
bership and non-membership function, these are as follows,
πA (x) = 1 − µA (x) − vA (x) (2)
Membership Function
is called the intuitionistic fuzzy index of x in A, it is 
 0 if x ≤ a1
a hesitancy degree of x to A and satisfies the inequality 

x−a1
 a2 −a1 if a1 ≤ x ≤ a2


0 ≤ πA (x) ≤ 1. Fuzzy inference in intuitionistic case 
implies working with the membership function µ and the non- µA (x) = 1 if a2 ≤ x ≤ a3
x−a4

membership function v. Hence, the Output of an intuitionistic 


 a3 −a4 if a3 ≤ x ≤ a4
fuzzy system can be calculated as follow, 
0 if a4 ≤ x
IF S = (1 − π) ∗ F Sµ + πF S ∗ v (3) Non-Membership Function

A. Operations on IFS 
 1 if x ≤ b1

x−b1
if b1 ≤ x ≤ b2

There are several operation performed on IFS, some of these 
 b2 −b1

are as follows: [4] [5] vA (x) = 0 if b2 ≤ x ≤ b3
Union: 

 x−b4
if b3 ≤ x ≤ b4


 a3 −a4
A ∪ B = {(x, max (µA (x) , µB (x)) , min (vA (x) , vB (x)))}
1 if b4 ≤ x
(4)
1) Triangular Function: Triangular membership function
Intersection:
of IFLS can be represented as,
A ∩ B = {(x, min (µA (x) , µB (x)) , max (vA (x) , vB (x)))}
(5) Membership Function
Addition 

0 if x≤a
 x−a

if a≤x≤b
A+B = {(x, µA (x) + µB (x) − µA (x) .µB (x) , vA (x) .vB (x))} b−c
µA (x) = c−x
(6)  if b≤x≤c
 c−b

Subtraction:

0 if c≤x
A−B =A∩B (7)
Non-Membership Function
III. I NTUITIONISTIC F UZZY L OGIC S YSTEM 
 1  if x ≤ a
Intuitionistic fuzzy systems has two function, the member-

 
1 − x−a

if a ≤ x ≤ b
ship functions as well as the non-membership functions. In vA (x) =  b−c 
this case, we compute that the conclusion of an IFS can be 

 1 − c−x
c−b if b ≤ x ≤ c
a linear combination of the results of two traditional fuzzy

if c ≤ x

1
systems, one for the membership functions and the other for
a non-membership function.An IFLS comprises of input(s), 2) Trapezoidal Function: Trapezoidal Function of IFLS
fuzzifier, fuzzy inference engine,rule base, defuzzifier and can be represented as,
output processor as shown in Fig. 1.
 Fig. 2. Triangular MF and NMF Fig. 4. R-function MF and NMF

Fig. 5. Gaussian MF and NMF

Fig. 3. Trapezoidal MF and NMF

Membership Function 4) Gaussian Function: Gaussian Function of IFLS can be

 represented as,


0 if x≤a Membership Function
 x−a a≤x≤b


b−c if !
(x − m)

µA (x) = 1 if b≤x≤c µA (x) = exp − 2 (8)
 d−x α(k)
if c≤x≤d




 d−c
0 if d≤x Non-Membership Function
Non-Membership Function !!
(x − m)
vA (x) = 1 − exp − (9)


 1   if x ≤ a α(k)
2

 x−a



 1 − b−c if a ≤ x ≤ b
vA (x) = 0
  if b ≤ x ≤ c B. Intuitionistic Fuzzy Rule Base System

d−x
− if c ≤ x ≤ d



 1 d−c Fuzzy rules are used within fuzzy logic systems to infer



1 if d ≤ x an output based on input variables. Fuzzy rules are linguistic
IF-THEN constructions that have the general form (IF A
3) R-Function: R-Function of IFLS can be represented as,
THEN B)where A and B are (collections of) propositions
containing linguistic variables. A is called the premise and B
Membership Function
 is the consequence of the rule. In effect, the use of linguistic
0
 if x ≥ d variables and fuzzy IF-THEN rules exploits the tolerance for
µA (x) = d−x
if c ≤ x ≤ d imprecision and uncertainty.
 d−c
1 if c ≤ x

C. Intuitionistic Inference System
Non-Membership Function The Takagi-Sugeno type [18] IFIS model for fuzzification
and De-fuzzification process having following steps:

1   if x ≥ d

Step1:The input variables are compared with the member-

d−x
vA (x) = 1− d−c if c ≤ x ≤ d ship functions µA (x) and Non-membership functions vA (x).

if c ≤ x Step2:after that operators like AND, OR, NOT are applied in

0
the IF-THEN rules. Therefore, the firing weight of each rule IV. IFLS A PPLICATIONS
is obtained. Further, the outputs of each rule are generated. An intuitionistic fuzzy logic theory has been successfully
In the defuzzification process, the final output is the weighted applied in the areas of Medical diagnosis, multi attributes de-
average or weighted sum of each IF-THEN rule’s output. cision [24], pattern recognition [25] [26], battlefield situation
An intuitionistic fuzzy set (IFS) A in X is defined as, assessment [27], medical image processing [28],etc.
A = {(x, µA (x) , vA (x))} (∀x ∈ X) (10) There are some application which is proposed by researchers,
the design of an IFLS controller for heater fans on the
The hesitation part is defined as, basis of IFS were introduced in [31]. The ordinary traffic
πA (x) =1-µA (x) -vA (x). where, 0 ≤ πA (x) ≤ 1 controller helpless to tackle the arrangement of issue so an
The kth IF-THEN, rule Rk , k=1,2, ... ,N, in IFIS can be insightful transport system based of intuitionistic fuzzy logic
expressed as follows: is proposed in [33]. To monitoring non-linear dynamic plant
Rk : if → x1 isA1,k AN Dx2 isA2,k AN D...AN Dxi isAi,k the intuitionistic fuzzy inference system is applied [29]. For
AN D...AN Dxn isAn,k . determination of washing time for a washing machine is
then, → yk = f (x1 , x2 , ..., xn ) = a1,k x1 + a2,k x2 ....... + developed using an intuitionistic fuzzy logic controller in [32].
ai,k xi + ..... + an,k xn + bk .
where, A1,k , A2,k , Ai,k , An,k represents IF-sets and yk is V. C ASE S TUDY
a output of the k-th rule represented by a linear combination
In this paper, we are taking the cardiac risk assessment as
of inputs x1 , x2 , xi ...xn .
a case study. In which there are 11 input variable associated
The final output Y of the Intuitionistic fuzzy inference system
with the cardiac health and one output variable associated with
of Takagi-Sugeno type can be calculated by, the outputs
cardiac risk [13].
y µ of FIS µ uses the membership function µA (x) and y v
non-membership function vA (x). For all N if-then rules Rk A. Input Variable
weightedPaverages(WA) or weighted sums(WS) is defined as:
u
N µ µ
yk wk v
PN v v
yk wk 1) Cholesterol: For cholesterol input variable one uses the
yW A = PN wµk=1
yW A = PN wv
k=1
k=1 k k=1 k estimation of low density lipoprotein cholesterol. An intuition-
u
P N
yW S = k=1 yk wk µ µ v
PN
yW S = k=1 yk wk v v istic fuzzy number(IFN) as gives as follow:
Membership Function
where, wkµ and wkv are firing weights, and (
1 if x ≤ 151
µlow (x) = 197−x
wkµ = µ (x1 ) AN Dµ (x2 ) AN D........µ (xn ) (11) 46 if 151 ≤ x ≤ 197
wkv = v (x1 ) AN Dv (x2 ) AN D........v (xn ) (12)

x−188
then, from the equation 3, the composition of outputs yµ and  27
 if 188 ≤ x ≤ 215
yv can be defined as follows: µmed (x) = 1 if x = 215
 250−x

y = (1 − π) yµ + πyv (13) 35 if 215 ≤ x ≤ 250

where, π is the weight of the output yv . By using the

Godel t-norm, wkµ and wkv be firing weights which are

x−217
 46
 if 217 ≤ x ≤ 263
computed as follows [36] [37]: µhigh (x) = 1 if x = 263
 307−x

if 263 ≤ x ≤ 307
wkµ = (µ (x1 ) , µ (x2 ) , ..........µ (xn )) (14) 44

wkv = (v (x1 ) , v (x2 ) , ..........v (xn )) (15) (

x−281
if 281 ≤ x ≤ 347
then, Wk = wkµ
− wkv
when the weighted average IFWA µv.high (x) = 66

is defined as: 1 if 347 ≤ x

PN µ v Non-Membership Function
k=1 Yk (wk − wk )
u
yIF W A = P N µ
F or (wkµ − wkv ) ≥ 0 (16) (
x−174
k=1 (w k − w v)
k 36 if 174 ≤ x ≤ 210
vlow (x) =
and the weighted sum (IFWS) is as follows: 1 if 210 ≤ x
N 
X 1 if x ≤ 170
u
yIF WA = Yk (wkµ − wkv )

(17) 

215−x
170 ≤ x ≤ 215

k=1

 45
 if
These defuzzification methods are define based on the differ- vmed (x) = 0 if x = 215
ence between the firing weights wkµ and wkv , which have to be x−215

if 215 ≤ x ≤ 270



 55
positive.

1 if 270 ≤ x
 TABLE I
B LOOD PRESSURE VALUES

Parameter low Medium High Very High

MF 111-134 127-139-153 142-157-172 154-171
NMF 123-144 115-139-170 125-157-190 140-163

TABLE II
ELECTROCARDIOGRAPHY (ECG) VALUES
Fig. 6. Cholesterol input Membership Function
Parameter Normal ST-T Abnormal Hypertrophy
MF -0.5- 0.07- 0.4 0.25- 1 -1.75 1.4- 1.8- 2.5
NMF -0.5- 0.2- 0.6 0- 1- 2 1- 1.6- 2.5

5) Maximum heart rate: This input variable associated with

the heart rate of patient in 24 hours and has the values as:
Low, Medium, High(Low and high are trapezoidal function,
Medium is triangular function).As shown in tableIII
6) Old peak: This means ST-segment misery initiated by
exercise with respect to rest and it has 3 values: Low, Risk,
Fig. 7. Cholesterol input Non-membership function Terrible(Low and Terrible are trapezoidal function, Risk is a
triangular function).As shown in table IV
 7) Age: This input fields has 4 linguistic values: Young,
1
 if x ≤ 200 Mild, Old and Very Old, represented as intuitionistic fuzzy
numbers given by the following functions as shown in Table

 263−x 200 ≤ x ≤ 263


63 if
V.

vhigh (x) = 0 if x = 263
 x−263 8) Chest pain: This variable has numerical values associ-
if 263 ≤ x ≤ 320




 57 ated with disease:typical angina=1, atypical angina=2, non-
1 if 320 ≤ x angina pain=3 and asymptomatic=4.
 9) Exercise: This info variable has 2 esteems: if specialist
1
 if x ≤ 270
315−x
decides exercise test for patient, esteem is 1 and, something
vv.high (x) = if 270 ≤ x ≤ 315 else, esteem is 0.
 32
0 if 315 ≤ x

10) Thallium scan: This input variable has 3 numerical
qualities: 3=Normal,6=Fixed Defect and 7=Reversible Defect
2) Diabetes (Blood sugar):: This input variable has only
11) Sex: This variable has 2 values for patient gender: 0=
one linguistic value: True and its represented as:
male and 1= female.
(
x−105 B. Output variable
15 if 105 ≤ x ≤ 120
µtrue (x) = Membership Function
1 if 120 ≤ x
(
1 if x ≤ 0.25

1
 if x ≤ 80 µHealthy (x) = 1−x
vtrue (x) = 112−x
if 80 ≤ x ≤ 112 0.75 if 0.25 ≤ x ≤ 1
 32
0 if 112 ≤ 160


For remaining input variables we have made the tables TABLE III
for its membership and Non-membership values and repre- M AXIMUM HEART RATE VALUES
sentation of this points according to the above two parame-
Parameter low Medium High
ters(Cholesterol and Diabetes).
MF 100-141 111- 152- 194 152- 216
3) Blood pressure: This input variable has 4 values: Low, NMF 120- 160 90- 152- 210 130- 154
Medium, High, Very high. Low and Very high sets are
represented by trapezoidal fuzzy numbers. Medium and High
TABLE IV
sets are by triangular fuzzy numbers. The membership and O LD PEAK VALUES
non membership values are as shown as:
4) Electrocardiography (ECG): ECG has three linguistic Parameter low Risk Terrible
values: 1.Normal 2.ST-T Abnormal 3.Hypertrophy.This vari- MF 0-1-2 1.5-2.8-4.2 2.55-4
ables intuitionistic Fuzzy numbers are shown in table II NMF 1.5-3 1-2.8-5 2-3.2
 TABLE V TABLE VI
AGE VALUES RULE BASE
Parameter Young Mild Old Very old Rule Parameter Linguistic Variable(If) Result(Then)
MF 29-38 33-38-45 40-48-58 52-60 R1 Blood Pressure Low Healthy
NMF 35-45 30-38-50 35-48-63 47-56 R2 Blood Pressure Medium risk1
R3 Blood Pressure High risk2
R4 Blood Pressure High risk3
R5 Blood Pressure Very high risk4

if x ≤ 1 R6 Cholesterol Low Healthy
x

R7 Cholesterol Medium risk1
µrisk1 (x) = 1 if x = 1 R8 Cholesterol High risk2

2−x if 1 ≤ x ≤ 2 R9 Cholesterol High risk3

R10 Cholesterol Very High risk3
R11 Blood sugar true risk4

x − 1
 if 1 ≤ x ≤ 2
R12 Electrocardiography (ECG) Normal Healthy
µrisk2 (x) = 1 if x = 2 R13 Electrocardiography (ECG) Normal risk1


3−x if 2 ≤ x ≤ 3 R14 Electrocardiography (ECG) ST-T Abnormal risk2
R15 Electrocardiography (ECG) Hypertrophy risk3
 R16 Electrocardiography (ECG) Hypertrophy risk4
x − 2
 if 2 ≤ x ≤ 3 R17 Max Heart Rate Low Healthy
µrisk3 (x) = 1 if x = 3 R18 Max Heart Rate Medium risk1
 R19 Max Heart Rate Medium risk2
4−x if 3 ≤ x ≤ 4

R20 Max Heart Rate High risk3
( R21 Max Heart Rate High risk4
x−3
0.75 if 3 ≤ x ≤ 3.75 R22 Old Peak Low Healthy
µrisk4 (x) = R23 Old Peak Low risk1
1 if 3.75 ≤ x
R24 Old Peak Terrible risk2
Non-Membership Function R25 Old Peak Terrible risk3
( R26 Old Peak Risk risk4
x−0.6
if 0.6 ≤ x ≤ 1.25 R27 Age Young Healthy
vhealthy (x) = 0.65 R28 Age Mild risk1
1 if 1.25 ≤ x R29 Age Old risk2
 R30 Age old risk3
1−x if x≤1 R31 Age Very Old risk4
R32 chest pain typical angina Healthy


0 if x=1
vrisk1 (x) = x−1 R33 chest pain atypical angina risk1

 1.5
 if 1 ≤ x ≤ 2.5 R34 chest pain non-angina pain risk2

1 if 2.5 ≤ x R35 chest pain asymptomatic risk3
R36 chest pain asymptomatic risk4
 R37 Exercise true risk2


 1 if x ≤ 0.5 R38 Thallium Normal Healthy
2−x
0.5 ≤ x ≤ 2 R39 Thallium Normal risk1


 1.5
 if
R40 Thallium Fixed Defect risk2
vrisk2 (x) = 0 if x=2 R41 Thallium Reversible Defect risk3
x−2

if 2 ≤ x ≤ 3.5



 1.5 R42 Thallium Reversible Defect risk4
R43 Sex Female risk1

1 if 3.5 ≤ x
R44 sex Male risk2


 1 if x ≤ 1.5
 3−x

if 1.5 ≤ x ≤ 3 TABLE VII
vrisk13 (x) = 1.5 I NPUT C RISP VALUE ’ S

 0 if x=3
 Parameter Crisp i/p value
x−3 3≤x≤4

if
Blood Pressure 117 (Low)
( Cholesterol 230 (High)
1 if x ≤ 140 Blood Sugar 130 (True)
vrisk4 (x) =
3.5 − x if 2.5 ≤ x ≤ 3.5 ECG 0 (Normal)
Max. Heart Rate 160 (High)
Old Peak 1.4 (Low)
Age 60 (Very Old)
Chest Pain 4 (Asymptomatic)
C. Knowledge representation rule base Exercise 1 (True)
Knowledge representation of proposed system is shown in Thallium 7 (Reversible)
Sex 1 (Male)
table VI
D. Result And Discussion
We have considered some input values as taken in [13],
as shown in table ,This Crisp input values applied to the
system, according to the input values, specific rule is triggerd
and we get the membership and non-membership grade values.
This values are inferred with output values by intuitionistic
fuzzy inference method described above in IFLS. And finally
we get the defuzzified crisp output values.
Output crisp values as a result are shown in Table VIII
TABLE VIII
O UTPUT CRISP VALUE
Rule R1 R9 R11 R12 R20 R22 R31
Crisp output 0.462 2.96 2.0 0.125 2.38 1.1 3.5
Rule R35 R37 R41 R44
Crisp output 3.0 2.0 3.0 2.0
VI. C ONCLUSION
In this paper, mathematics of an intuitionistic fuzzy set
and structure of IFLS is discussed with the case study for a
diagnosis of cardiovascular diseases. While making decision or
giving opinion, uncertainty or hesitancy appear. This hesitancy
is more precisely handled by Intuitionistic fuzzy logic system.
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