Cardiologent：用于患者级心律失常评估、紧急情况和管理的多智能体临床决策支持
Cardiologent: Multi-Agent Clinical Decision Support for Patient-Level Arrhythmia Assessment, Urgency, and Management
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中文总结 AI 辅助
研究针对患者级心律失常决策支持问题，提出多智能体系统Cardiologent，每个信号对应智能体基于测量特征读取数据，整合为心律概况并对照指南推理，经评估在多方面表现最佳，使决策可审核，向连续监测迈进。
中文摘要 AI 辅助
同一房颤发作在健康成年人中是轻微发现，而在老年高血压患者中则是抗凝依据：相同信号，不同决策。命名心律只是开始，决定患者预后的是后续判断。近期将大语言模型与心电图结合的工作未达此深度，仅读取单个记录未整合患者级发现；围绕其构建的智能体系统要么接收设备已检测到的心律失常，要么针对不同诊断任务，在该任务所需决策前停止。我们将患者级心律失常决策支持制定为一项任务，并提出Cardiologent，一个从检测到决策的多智能体系统。每个信号对应一个智能体，其窗口读取基于测量特征而非单纯标签；读取结果整合为患者心律概况，并结合患者自身数据，对照为该病例检索的临床指南进行推理，有一个评论家根据所引用的指南检查每个结论。我们评估临床决策而非报告，涵盖综合诊断、临床意义、紧急情况和管理。Cardiologent在各方面得分最高，在心脏病专家和大规模语言模型评判下的每个患者级任务中均排名第一，且与心脏病专家的一致性（ICC分别为0.74、0.66）与他们之间的一致性（0.67）相当。由于每个结论都可追溯到引用的指南并经心脏病专家验证，其产生的决策临床医生可审核而非盲目执行，朝着用于连续监测迈出了一步。
英文摘要
The same episode of atrial fibrillation is a minor finding in a healthy adult and grounds for anticoagulation in an elderly patient with hypertension: identical signal, opposite decision. Naming the rhythm is only the start; what determines a patient's outcome is the judgement that follows -- what the arrhythmia is across the whole record, what it means for this patient, and what should be done about it. Recent work pairing large language models with the ECG stops short of this, reading one recording without assembling a patient-level finding; and agentic systems built around it either receive the arrhythmia a device has already detected or target a different diagnostic task, stopping before the decision this task requires. We formulate patient-level arrhythmia decision support as a task and present Cardiologent, a multi-agent system that spans it from detection to decision. An agent for each signal -- a single ECG lead and the photoplethysmogram a wearable acquires -- grounds its window reading in measured features rather than a bare label; the readings are assembled into the patient's rhythm profile and, with the patient's own data, reasoned against clinical guidelines retrieved for the case, with a critic checking each conclusion against the guideline it cites. We evaluate the clinical decision rather than the report, across integrated diagnosis, clinical significance, and urgency and management. Cardiologent scores highest on every axis, first on every patient-level task under both cardiologists and an at-scale LLM judge -- whose agreement with the cardiologists (ICC 0.74, 0.66) matches theirs with each other (0.67). Because each conclusion traces to a cited guideline and is validated against expert cardiologists, it yields decisions a clinician can audit rather than act on blindly -- a step toward use in continuous monitoring.
