A Structural FHMM for Interpretable Disease Trajectories in T2DM

In this work, we propose a structural variant of the Factorial Hidden Markov Model (FHMM) for the analysis of disease trajectories in patients with Type 2 diabetes mellitus (T2DM). The model represents a patient's latent health state as a combination of multiple independent, simultaneously evolving components, associated with comorbidities and lab results. This structured latent representation facilitates the identification of clinically meaningful patient states and clustering of common disease trajectories. We evaluate the proposed approach using The IQVIA Medical Research Data incorporating data from THIN, a Cegedim database of anonymized electronic health records (EHR), identifying patients with a first-ever prescription for a non-insulin antidiabetic drug (NIAD) between January 2006 and December 2019. The model identifies multiple clinically coherent latent components corresponding to known patterns of diabetes-related complications and reveals heterogeneous progression pathways, including distinct microvascular-dominant and multi-organ trajectories associated with elevated comorbidity burden and mortality. These results demonstrate that the proposed framework captures meaningful longitudinal structure in EHR data and provides interpretable insights into the evolution of T2DM and its comorbidities.

Intervention-Aware Clinical World Model for Post-Op Outcome Forecasting in Cardiology

Many clinical prediction models treat post-intervention outcomes as a one-step mapping from baseline measurements to a future endpoint. However, recovery after a procedure often unfolds as an irregular trajectory: clinical observations, medication changes, repeat interventions, and physiological measurements are recorded asynchronously and can change risk assessment over time. We propose an intervention-aware clinical world model that represents each patient with a structured latent state and evolves it through time-ordered post-intervention events. The model first encodes baseline imaging into a 3D spatial latent state. It then updates this state using procedural context, static covariates, elapsed time, and peri-event physiological embeddings. Follow-up imaging provides training-only supervision through a latent forecasting objective. We apply the framework to atrial fibrillation ablation. During the 90-day recovery window, irregular post-procedure records provide clinically meaningful evidence for long-term recurrence risk. In repeated internal cross-validation on DECAAF-II, our model achieves AUROC 0.756 and AUPRC 0.777 for recurrence prediction. It also achieves a scar-extent MAE of 2.971 percentage points without requiring follow-up MRI intensities at inference. The learned state supports recurrence-risk queries at different horizons and retrospective input editing of blanking-period records.