Federated Learning for Cardiovascular Disease Prediction: A Comparative Review of Biosignal- and EHR-Based Approaches

Federated Learning (FL) has emerged as a promising framework for multi-institutional medical artificial intelligence, enabling collaborative model development while preserving data privacy and security. Despite increasing research on federated approaches for cardiovascular disease prediction, previous reviews have largely focused on disease-specific perspectives without systematically comparing data modalities. This study comprehensively examines 28 representative investigations from the past five years, including 17 biosignal-based and 11 electronic health record (EHR)-based applications. Biosignal-based FL emphasizes personalized electrocardiogram (ECG) classification, mitigation of non-independent and identically distributed (Non-IID) data, and Internet of Things (IoT)-based monitoring using methods such as client clustering, asynchronous learning, and Bayesian inference. In contrast, EHR-based studies prioritize large-scale hospital collaboration, adaptive optimization, and secure aggregation through distributed frameworks. By systematically comparing methodological strategies, performance trade-offs, and clinical feasibility, this review highlights the complementary strengths of biosignal- and EHR-based approaches. Biosignal frameworks show strong potential for personalized, low-latency cardiac monitoring, whereas EHR frameworks excel in scalable and privacy-preserving decision support. Building upon the limitations of earlier reviews, this paper introduces data-type-centric design guidelines to enhance the reliability, interpretability, and clinical scalability of FL in cardiovascular diagnosis and prediction.