<![CDATA[Heart disease is the leading cause of death in Indonesia and globally, necessitating an early screening system that is both accurate and clinically trustworthy. Although XGBoost demonstrates high predictive performance, its black-box nature undermines clinical trust, while low recall risks missed diagnosis an unacceptable consequence in population screening, especially in middle-income countries with limited healthcare resources. This study aims to develop a sensitive, transparent, and implementation-ready heart disease screening framework through the integration of SHAP-based Explainable AI. The CDC's Indicators of Heart Disease dataset (319,795 samples) was processed according to WHO/CDC standards, followed by class imbalance handling, hyperparameter optimization using RandomizedSearchCV, evaluation based on metrics sensitive to minority classes (AUC, recall, F1-score, AUC-PR), and threshold tuning to maximize recall. The baseline model showed a very low recall of 12.18%. After optimization and threshold tuning at 0.10, the model achieved recall >96% (96.79%) with a G-mean of 0.7477, supported by SHAP interpretation stability and the ability to capture non-linear interactions between advanced age (AgeCategory_WHO) and poor general health (GenHealth). SHAP analysis confirmed the alignment of dominant features with medical evidence, and its visualizations provide transparent explanations for healthcare professionals indicating its potential implementation as an interpretable clinical decision support system.]]>
