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A comprehensive inference-time augmentation framework in physiological signals: application to PPG-based AF

Davood Fattahi¹, Runze Yan¹, Saurabh Kataria¹

¹Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States of America.

Physiological Measurement

|June 15, 2026

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This study introduces a unified inference-time augmentation (ITA) framework to enhance the accuracy of physiological signal classification, particularly for atrial fibrillation detection using photoplethysmography (PPG) signals.

Area of Science:

Biomedical Engineering
Signal Processing
Machine Learning

Background:

Physiological signal classification faces challenges like noise and data shifts in real-world use.
Inference-time augmentation (ITA) improves robustness but has been limited in scope for physiological signals.
Existing ITA methods use few augmentations with unoptimized parameters.

Purpose of the Study:

To propose a unified inference-time augmentation (ITA) framework for physiological signals.
To systematically optimize ITA hyperparameters using Bayesian optimization.
To enhance the reliability of atrial fibrillation (AF) detection from photoplethysmography (PPG) signals.

Main Methods:

Developed a framework with 13 augmentation methods (time, amplitude, frequency, artifact injection).

Keywords:

artificial intelligence atrial fibrillation detection inference time augmentation photoplethysmography physiological signals

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Employed Bayesian optimization for systematic hyperparameter tuning.

Evaluated on AF detection using GPT-PPG and ResNet models across five PPG datasets (~9,800 hours).

Main Results:

Standard ITA improved AUROC (up to 8.5%) and AUPRC (up to 10.6%) across models and datasets.
Selective ITA reduced false positive rates (FPR) by up to 4.4% on non-AF datasets.
Consistent performance gains observed for both GPT-PPG and ResNet architectures.

Conclusions:

ITA is a practical, model-agnostic method for improving PPG-based AF classification in deployment.
The unified framework enhances robustness against noise and data shifts without retraining.
Findings support broader application of ITA in physiological signal analysis.