A Configurable Multi-Modal Clinical Time-Series Platform for Predictive Modeling in Cardiology

Predictive models for cardiovascular disease rely predominantly on electronic health records (EHRs), whereas wearable devices, home monitoring, and patient-reported outcomes offer new opportunities for multimodal risk prediction; however, integrating these heterogeneous sources into a reproducible, clinically usable machine learning workflow remains challenging. This study aimed to develop an end-to-end architecture for explainable multimodal time-series prediction in patients with heart failure (HF), left ventricular assist device (LVAD) recipients, and heart transplant (HT) recipients.

The modular architecture harmonizes Health Level Seven Fast Healthcare Interoperability Resources (HL7 FHIR) and non-FHIR telemonitoring data into a unified event log, which leakage-aware temporal preprocessing converts into patient-day feature matrices. Configurable adverse-event tasks (HF hospitalization, cardiac decompensation, transplant rejection, and mortality) are modeled using gradient-boosted trees or temporal neural networks, with optional probability calibration. Explanations combine SHapley Additive exPlanations (SHAP) for tabular models with temporal-perturbation attribution and integrated gradients for sequence models. The pipeline is declaratively configured, tracked with MLflow, and deployable via command-line and web interfaces. It was developed alongside the prospective multicenter RETENTION trial of a telemonitoring-based care pathway and was subsequently applied to data collected within the trial.

Applied to the RETENTION cohort, the framework executed the complete workflow, from heterogeneous source data to per-patient-day probability estimates for each prediction task, with feature- and time-level explanations presented as clinician-facing narratives. The cohort served to demonstrate the architecture, not to establish clinical predictive performance or prospective clinical validation.

This study provides a reproducible, end-to-end architecture that unifies data harmonization, temporal processing, machine learning orchestration, explainability, and deployment for multimodal clinical prediction. Its modular, disease-agnostic design supports adaptation to other diseases, settings, and data sources, laying a foundation for prospective validation and clinical translation.