Speaker
Haider Warraich, MD
Program Manager
ARPA-H (Advanced Research Projects Agency for Health)
Keywords
AI; Outpatient Care; Agentic AI; Heart Failure; Clinical Care
Key Points
- The current state of outpatient care is sporadic and reactive. Low-value care leads to excess costs and harms, and clinical resources are wasted on administrative tasks. Clinical agentic AI could provide patients with round-the-clock access to specialty care and unlock the full potential of the Electronic Health Record and wearables.
- ADVOCATE is envisioned as a patient-facing agentic AI system that can provide 24/7 clinical care as an extension of the care team. It would include administrative and wellness functions, like care navigation and diet and exercise recommendations; advanced decision support in regard to treatment and diagnosis; and high-risk functions, like prescription management. The ARPA-H team hopes it will transform advanced cardiovascular disease management.
- Their current focuses are the development of an agent for patients with heart failure; the development of an independent supervisory agent to ensure continued agent accuracy and patient safety, particularly after clinical deployment; and recruitment of health systems for the design, development, and deployment of the technologies.
- The clinical evaluation strategy for ADVOCATE will involve 3 phases: Human Factors Evaluation and simulated virtual patient testing; shadow-mode evaluation in clinically deployed settings; and a stepped-wedge multicenter cardiovascular outcomes trial.
Discussion Themes
While underlying foundation AI models possess broad medical knowledge, their autonomous actions must be strictly constrained to their labeled, intended use to maintain safety.
Heart failure was selected – as opposed to upstream prevention – in part because it is characterized by a highly algorithmic care path, a high event rate that generates clinical study data quickly, and strong financial incentives.
While the program initially targeted non-inferiority compared to a cardiologist, the metric was updated to require a superiority analysis against usual care.