A framework for longitudinal health AI agents

Although artificial intelligence (AI) agents are increasingly proposed to support potentially longitudinal health tasks, such as symptom management, behaviour change and patient support, most current implementations fall short of facilitating user intent and fostering accountability. This contrasts with prior work on supporting longitudinal needs, both within and beyond clinical settings, where follow-up, coherent reasoning and sustained alignment with individuals' goals are critical for both effectiveness and safety. In this Perspective, we draw on established clinical and personal health informatics frameworks to define what it would mean to orchestrate longitudinal health interactions with AI agents. We propose a multilayer framework and corresponding agent architecture that operationalizes Coherence, Continuity, Adaptation and Agency across repeated interactions. Through representative use cases, we demonstrate how longitudinal agents can maintain meaningful engagement, adapt to evolving goals and support safe, personalized decision-making over time. Our findings underscore both the promise and the complexity of designing systems capable of supporting health trajectories beyond isolated interactions, and we offer guidance for future research and development in multisession, user-centred health AI.