# Framework for Grounding Healthcare LLMs in a Causal Knowledge Graph: A Cardiovascular Example Pilot

arXiv: https://arxiv.org/abs/2608.15382 · HTML: https://mlsanity.com/paper/2608.15382/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 13 of its 33 references that are in the map.
- First posted on arXiv 15 Aug 2026.

## Builds on (most cited first, 13 of 13)

- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [TruthfulQA: Measuring How Models Mimic Human Falsehoods](https://mlsanity.com/paper/2109.07958/) (2021)
- [Survey of Hallucination in Natural Language Generation](https://mlsanity.com/paper/2202.03629/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [From Local to Global: A Graph RAG Approach to Query-Focused Summarization](https://mlsanity.com/paper/2404.16130/) (2024)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [FActScore: Fine-grained Atomic Evaluation of Factual Precision in Long Form Text Generation](https://mlsanity.com/paper/2305.14251/) (2023)
- [Causal Reasoning and Large Language Models: Opening a New Frontier for Causality](https://mlsanity.com/paper/2305.00050/) (2023)
- [Measuring Attribution in Natural Language Generation Models](https://mlsanity.com/paper/2112.12870/) (2021)
- [Causal Parrots: Large Language Models May Talk Causality But Are Not Causal](https://mlsanity.com/paper/2308.13067/) (2023)
- [Attributed Question Answering: Evaluation and Modeling for Attributed Large Language Models](https://mlsanity.com/paper/2212.08037/) (2022)

## Abstract (arXiv)

Large language models (LLMs) are increasingly proposed for healthcare decision support, but their evaluations still reward single-answer accuracy rather than reasoning about interventions, mechanisms, harms, evidence, and uncertainty. We propose a reproducible, graph-centered evaluation framework for intervention-oriented LLM behavior in healthcare and stress-test it in a cardiovascular pilot. The framework has four components: (i) a domain causal knowledge graph in which assertions are first-class, provenance-preserving nodes with stable identifiers; (ii) a scenario-conditioned subgraph extraction step that, given any clinical scenario, retrieves the relevant reified-assertion subgraph; (iii) four controlled grounding conditions that vary how the retrieved subgraph is composed into the model's context (ungrounded C1, knowledge-graph C2, causal-graph C3, integrated C4); and (iv) an automated scoring pipeline, anchored on assertion identifiers, that computes intervention accuracy, and other evaluation measures on a single pass. To test the framework, we built a category-balanced scenario generator across eight reasoning failure modes and instantiated it on a cardiovascular graph. The metric panel discriminates conditions along interpretable, non-redundant axes: C4 obtains the strongest causal edge F1 (0.838), adverse-effect F1 (0.833), evidence accuracy (0.738), and unsupported claim rate (0.114), while C1 obtains the highest raw intervention accuracy (0.948) with no measurable causal or evidential grounding.