Jose Geraldo Fernandes

Jose Geraldo Fernandes, Luiz Facury, Pedro Robles Dutenhefner et al.

Self-supervised learning in healthcare has largely relied on invariance-based objectives, which maximize similarity between different views of the same patient. While effective for static anatomy, this paradigm is fundamentally misaligned with clinical diagnosis, as it mathematically compels the model to suppress the transient pathological changes it is intended to detect. We propose a shift towards Action-Conditioned World Models that learn to simulate the dynamics of disease progression, or Event-Conditioned. Adapting the LeJEPA framework to physiological time-series, we define pathology not as a static label, but as a transition vector acting on a patient's latent state. By predicting the future electrophysiological state of the heart given a disease onset, our model explicitly disentangles stable anatomical features from dynamic pathological forces. Evaluated on the MIMIC-IV-ECG dataset, our approach outperforms fully supervised baselines on the critical triage task. Crucially, we demonstrate superior sample efficiency: in low-resource regimes, our world model outperforms supervised learning by over 0.05 AUROC. These results suggest that modeling biological dynamics provides a dense supervision signal that is far more robust than static classification. Source code is available at https://github.com/cljosegfer/lesaude-dynamics

Jose Geraldo Fernandes, Luiz Facury de Souza, Pedro Robles Dutenhefner et al.

Deep learning models have shown high accuracy in classifying electrocardiograms (ECGs), but their black box nature hinders clinical adoption due to a lack of trust and interpretability. To address this, we propose a novel three-stage training paradigm that transfers knowledge from multimodal clinical data (laboratory exams, vitals, biometrics) into a powerful, yet unimodal, ECG encoder. We employ a self-supervised, joint-embedding pre-training stage to create an ECG representation that is enriched with contextual clinical information, while only requiring the ECG signal at inference time. Furthermore, as an indirect way to explain the model's output we train it to also predict associated laboratory abnormalities directly from the ECG embedding. Evaluated on the MIMIC-IV-ECG dataset, our model outperforms a standard signal-only baseline in multi-label diagnosis classification and successfully bridges a substantial portion of the performance gap to a fully multimodal model that requires all data at inference. Our work demonstrates a practical and effective method for creating more accurate and trustworthy ECG classification models. By converting abstract predictions into physiologically grounded \emph{explanations}, our approach offers a promising path toward the safer integration of AI into clinical workflows.