# Zodiac: A Cardiologist-Level LLM Framework for Multi-Agent Diagnostics

arXiv: https://arxiv.org/abs/2410.02026 · HTML: https://mlsanity.com/paper/2410.02026/

## Key facts

- Cited by 11 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 16 of its 55 references that are in the map.
- First posted on arXiv 2 Oct 2024.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 16 of 16)

- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Sentence-BERT: Sentence Embeddings using Siamese BERT-Networks](https://mlsanity.com/paper/1908.10084/) (2019)
- [MetaGPT: Meta Programming for A Multi-Agent Collaborative Framework](https://mlsanity.com/paper/2308.00352/) (2023)
- [Improving Factuality and Reasoning in Language Models through Multiagent Debate](https://mlsanity.com/paper/2305.14325/) (2023)
- [ChatEval: Towards Better LLM-based Evaluators through Multi-Agent Debate](https://mlsanity.com/paper/2308.07201/) (2023)
- [BioGPT: Generative Pre-trained Transformer for Biomedical Text Generation and Mining](https://mlsanity.com/paper/2210.10341/) (2022)
- [Mixture-of-Agents Enhances Large Language Model Capabilities](https://mlsanity.com/paper/2406.04692/) (2024)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [Capabilities of Gemini Models in Medicine](https://mlsanity.com/paper/2404.18416/) (2024)
- [Med42-v2: A Suite of Clinical LLMs](https://mlsanity.com/paper/2408.06142/) (2024)
- [Multimodal ChatGPT for Medical Applications: an Experimental Study of GPT-4V](https://mlsanity.com/paper/2310.19061/) (2023)
- [A Comprehensive Evaluation of Large Language Models on Benchmark Biomedical Text Processing Tasks](https://mlsanity.com/paper/2310.04270/) (2023)
- ["Brilliant AI Doctor" in Rural China: Tensions and Challenges in AI-Powered CDSS Deployment](https://mlsanity.com/paper/2101.01524/) (2021)
- [The Three Ghosts of Medical AI: Can the Black-Box Present Deliver?](https://mlsanity.com/paper/2012.06000/) (2020)
- [Retrieving Evidence from EHRs with LLMs: Possibilities and Challenges](https://mlsanity.com/paper/2309.04550/) (2023)

## Built on by (most cited first, 11 of 11)

- [From LLM Reasoning to Autonomous AI Agents: A Comprehensive Review](https://mlsanity.com/paper/2504.19678/) (2025)
- [Uncovering Vulnerabilities of LLM-Assisted Cyber Threat Intelligence](https://mlsanity.com/paper/2509.23573/) (2025)
- [On the Eligibility of LLMs for Counterfactual Reasoning: A Decompositional Study](https://mlsanity.com/paper/2505.11839/) (2025)
- [EquiMem: Calibrating Shared Memory in Multi-Agent Debate via Game-Theoretic Equilibrium](https://mlsanity.com/paper/2605.09278/) (2026)
- [The Trap of Trajectory: Towards Understanding and Mitigating Spurious Correlations in Agentic Memory](https://mlsanity.com/paper/2605.09330/) (2026)
- [SafeGPT: Preventing Data Leakage and Unethical Outputs in Enterprise LLM Use](https://mlsanity.com/paper/2601.06366/) (2026)
- [MedCoAct: Confidence-Aware Multi-Agent Collaboration for Complete Clinical Decision](https://mlsanity.com/paper/2510.10461/) (2025)
- [Agentic AI in Healthcare & Medicine: A Seven-Dimensional Taxonomy for Empirical Evaluation of LLM-based Agents](https://mlsanity.com/paper/2602.04813/) (2026)
- [Peccavi: Visual Paraphrase Attack Safe and Distortion Free Image Watermarking Technique for AI-Generated Images](https://mlsanity.com/paper/2506.22960/) (2025)
- [ECG-LLM -- training and evaluation of domain-specific large language models for electrocardiography](https://mlsanity.com/paper/2510.18339/) (2025)
- [Cardiologent: Multi-Agent Clinical Decision Support for Patient-Level Arrhythmia Assessment, Urgency, and Management](https://mlsanity.com/paper/2607.25340/) (2026)

## Abstract (arXiv)

Large language models (LLMs) have demonstrated remarkable progress in healthcare. However, a significant gap remains regarding LLMs' professionalism in domain-specific clinical practices, limiting their application in real-world diagnostics. In this work, we introduce ZODIAC, an LLM-powered framework with cardiologist-level professionalism designed to engage LLMs in cardiological diagnostics. ZODIAC assists cardiologists by extracting clinically relevant characteristics from patient data, detecting significant arrhythmias, and generating preliminary reports for the review and refinement by cardiologists. To achieve cardiologist-level professionalism, ZODIAC is built on a multi-agent collaboration framework, enabling the processing of patient data across multiple modalities. Each LLM agent is fine-tuned using real-world patient data adjudicated by cardiologists, reinforcing the model's professionalism. ZODIAC undergoes rigorous clinical validation with independent cardiologists, evaluated across eight metrics that measure clinical effectiveness and address security concerns. Results show that ZODIAC outperforms industry-leading models, including OpenAI's GPT-4o, Meta's Llama-3.1-405B, and Google's Gemini-pro, as well as medical-specialist LLMs like Microsoft's BioGPT. ZODIAC demonstrates the transformative potential of specialized LLMs in healthcare by delivering domain-specific solutions that meet the stringent demands of medical practice. Notably, ZODIAC has been successfully integrated into electrocardiography (ECG) devices, exemplifying the growing trend of embedding LLMs into Software-as-Medical-Device (SaMD).