# Bridging Performance Gaps for ECG Foundation Models: A Post-Training Strategy

arXiv: https://arxiv.org/abs/2509.12991 · HTML: https://mlsanity.com/paper/2509.12991/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 16 of its 48 references that are in the map.
- First posted on arXiv 16 Sep 2025.

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

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [Batch Normalization: Accelerating Deep Network Training by Reducing Internal Covariate Shift](https://mlsanity.com/paper/1502.03167/) (2015)
- [Layer Normalization](https://mlsanity.com/paper/1607.06450/) (2016)
- [SGDR: Stochastic Gradient Descent with Warm Restarts](https://mlsanity.com/paper/1608.03983/) (2016)
- [On the Opportunities and Risks of Foundation Models](https://mlsanity.com/paper/2108.07258/) (2021)
- [Deep Networks with Stochastic Depth](https://mlsanity.com/paper/1603.09382/) (2016)
- [InceptionTime: Finding AlexNet for Time Series Classification](https://mlsanity.com/paper/1909.04939/) (2019)
- [Time Series Classification from Scratch with Deep Neural Networks: A Strong Baseline](https://mlsanity.com/paper/1611.06455/) (2016)
- [Automatic diagnosis of the 12-lead ECG using a deep neural network](https://mlsanity.com/paper/1904.01949/) (2019)
- [Deep Learning for ECG Analysis: Benchmarks and Insights from PTB-XL](https://mlsanity.com/paper/2004.13701/) (2020)
- [ECG-FM: An Open Electrocardiogram Foundation Model](https://mlsanity.com/paper/2408.05178/) (2024)
- [Guiding Masked Representation Learning to Capture Spatio-Temporal Relationship of Electrocardiogram](https://mlsanity.com/paper/2402.09450/) (2024)
- [Sequence Modeling with Multiresolution Convolutional Memory](https://mlsanity.com/paper/2305.01638/) (2023)
- [Self-supervised Anomaly Detection Pretraining Enhances Long-tail ECG Diagnosis](https://mlsanity.com/paper/2408.17154/) (2024)

## Built on by (most cited first, 1 of 1)

- [Detecting low left ventricular ejection fraction from ECG using an interpretable and scalable predictor-driven framework](https://mlsanity.com/paper/2603.28532/) (2026)

## Abstract (arXiv)

ECG foundation models are increasingly popular due to their adaptability across various tasks. However, their clinical applicability is often limited by performance gaps compared to task-specific models, even after pre-training on large ECG datasets and fine-tuning on target data. This limitation is likely due to the lack of an effective post-training strategy. In this paper, we propose a simple yet effective post-training approach to enhance ECG foundation models. We evaluate it on a publicly available Transformer-based foundation model. Experiments across multiple ECG tasks show that our method consistently outperforms baseline fine-tuning. On the PTB-XL benchmarks, it improves macro AUROC by 0.7%-8.9% and macro AUPRC by 23.3%-77.9%, also outperforming several recent state-of-the-art approaches, including task-specific and advanced architectures. Further analyses demonstrate improved training dynamics and data efficiency, with only 30% of the training data outperforming the baseline trained on the full dataset. Ablation studies highlight the importance of stochastic depth and preview linear probing. These findings underscore the potential of post-training strategies to improve ECG foundation models, and we hope this work will contribute to the continued development of foundation models in the ECG domain.