From Hospital to Portables: A Universal ECG Foundation Model Built on 10+ Million Diverse Recordings

Artificial Intelligence (AI) has shown great promise in electrocardiogram (ECG) analysis and cardiovascular disease detection. However, developing a general AI-ECG model has been challenging due to inter-individual variability and the diversity of ECG diagnoses, limiting existing models to specific diagnostic tasks and datasets. Moreover, current AI-ECG models struggle to achieve comparable performance between single-lead and 12-lead ECGs, limiting the application of AI-ECG to portable and wearable ECG devices. To address these limitations, we introduce an ECG Foundation Model (ECGFounder), a general-purpose model that leverages real-world ECG annotations from cardiology experts to broaden the diagnostic capabilities of ECG analysis. ECGFounder is trained on over 10 million ECGs with 150 label categories from the Harvard-Emory ECG Database, enabling comprehensive cardiovascular disease diagnosis through ECG analysis. The model is designed to be both effective out-of-the-box and fine-tunable for downstream tasks, maximizing usability. More importantly, we extend its application to single-lead ECGs, enabling complex condition diagnoses and supporting various downstream tasks in mobile and remote monitoring scenarios. Experimental results demonstrate that ECGFounder achieves expert-level performance on internal validation sets for both 12-lead and single-lead ECGs, while also exhibiting strong classification performance and generalization across various diagnoses on external validation sets. When fine-tuned, ECGFounder outperforms baseline models in demographics detection, clinical event detection, and cross-modality cardiac rhythm diagnosis. The trained model and data will be publicly released upon publication through the bdsp.io. Our code is available at https://github.com/bdsp-core/ECGFounder.

Patient Contrastive Learning: a Performant, Expressive, and Practical Approach to ECG Modeling

Supervised machine learning applications in health care are often limited due to a scarcity of labeled training data. To mitigate this effect of small sample size, we introduce a pre-training approach, Patient Contrastive Learning of Representations (PCLR), which creates latent representations of ECGs from a large number of unlabeled examples. The resulting representations are expressive, performant, and practical across a wide spectrum of clinical tasks. We develop PCLR using a large health care system with over 3.2 million 12-lead ECGs, and demonstrate substantial improvements across multiple new tasks when there are fewer than 5,000 labels. We release our model to extract ECG representations at https://github.com/broadinstitute/ml4h/tree/master/model_zoo/PCLR.