# Cardiologent: Multi-Agent Clinical Decision Support for Patient-Level Arrhythmia Assessment, Urgency, and Management

arXiv: https://arxiv.org/abs/2607.25340 · HTML: https://mlsanity.com/paper/2607.25340/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 22 of its 44 references that are in the map.
- First posted on arXiv 28 Jul 2026.

## Builds on (most cited first, 22 of 22)

- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [G-Eval: NLG Evaluation using GPT-4 with Better Human Alignment](https://mlsanity.com/paper/2303.16634/) (2023)
- [Improving Factuality and Reasoning in Language Models through Multiagent Debate](https://mlsanity.com/paper/2305.14325/) (2023)
- [A Survey on LLM-as-a-Judge](https://mlsanity.com/paper/2411.15594/) (2024)
- [Encouraging Divergent Thinking in Large Language Models through Multi-Agent Debate](https://mlsanity.com/paper/2305.19118/) (2023)
- [One Fits All:Power General Time Series Analysis by Pretrained LM](https://mlsanity.com/paper/2302.11939/) (2023)
- [Automatic diagnosis of the 12-lead ECG using a deep neural network](https://mlsanity.com/paper/1904.01949/) (2019)
- [Can LLMs Understand Time Series Anomalies?](https://mlsanity.com/paper/2410.05440/) (2024)
- [GEM: Empowering MLLM for Grounded ECG Understanding with Time Series and Images](https://mlsanity.com/paper/2503.06073/) (2025)
- [ECG-Chat: A Large ECG-Language Model for Cardiac Disease Diagnosis](https://mlsanity.com/paper/2408.08849/) (2024)
- [Large language models can be zero-shot anomaly detectors for time series?](https://mlsanity.com/paper/2405.14755/) (2024)
- [MEIT: Multimodal Electrocardiogram Instruction Tuning on Large Language Models for Report Generation](https://mlsanity.com/paper/2403.04945/) (2024)
- [DEBATE: Devil's Advocate-Based Assessment and Text Evaluation](https://mlsanity.com/paper/2405.09935/) (2024)
- [Zodiac: A Cardiologist-Level LLM Framework for Multi-Agent Diagnostics](https://mlsanity.com/paper/2410.02026/) (2024)
- [anyECG-chat: A Generalist ECG-MLLM for Flexible ECG Input and Multi-Task Understanding](https://mlsanity.com/paper/2506.00942/) (2025)
- [ECG-R1: Protocol-Guided and Modality-Agnostic MLLM for Reliable ECG Interpretation](https://mlsanity.com/paper/2602.04279/) (2026)
- [Chat-TS: Enhancing Multi-Modal Reasoning Over Time-Series and Natural Language Data](https://mlsanity.com/paper/2503.10883/) (2025)
- [UniECG: Understanding and Generating ECG in One Unified Model](https://mlsanity.com/paper/2509.18588/) (2025)
- [ECG-Agent: On-Device Tool-Calling Agent for ECG Multi-Turn Dialogue](https://mlsanity.com/paper/2601.20323/) (2026)
- [CardAIc-Agents: A Multimodal Framework with Hierarchical Adaptation for Cardiac Care Support](https://mlsanity.com/paper/2508.13256/) (2025)

## Abstract (arXiv)

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.