Pre-AF 13: An Interpretable Atrial Fibrillation Risk Score Mined from Discharge Reports

Background. Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a major determinant of prognosis. Established AF risk scores rely on factors (older age, hypertension) nearly ubiquitous among patients with cardiovascular disease (CVD), offering limited stratification in this high-risk group. Most target long-term (5-10 year) rather than medium-term prediction. We developed interpretable ML models predicting AF risk over a 24-month and entire follow-up horizon in CVD patients using routinely collected hospital data. Methods. Single-center retrospective study of electronic health records from the National Research Cardiology Center (Russia) for patients aged >=18 with CVD but without pre-existing AF, hospitalized more than once between January 2012 and May 2019. A custom NLP pipeline transformed unstructured discharge reports into 73 structured features, combining a rule-based parser with transformer-based NER. Using LightAutoML we built a full model (73 features), a simple model (reduced subset), and a linear model for a bedside risk score. Performance was assessed by ROC AUC, compared with CHARGE-AF, C2HEST, MHS, and HAVOC, and interpreted via SHAP. Results. Of 80,576 records from 45,000 patients, 17,562 met inclusion criteria; 1,438 (8.19%) developed AF. The full model reached ROC AUC 0.735 (24-month) and 0.696 (entire follow-up); the simple model was nearly identical (0.725, 0.696). All non-linear models outperformed the four clinical risk scores (ROC AUC 0.53-0.64). The simple model uses 13 features and is named Pre-AF 13. SHAP identified age and left atrial volume as dominant predictors. A linear risk score (Pre-AF 9) stratified observed 24-month AF incidence from ~7% to 36%. Conclusion. Interpretable ML models built from routinely collected EHR data identify high-AF-risk CVD patients, outperforming established clinical risk scores.

ReDAct: Uncertainty-Aware Deferral for LLM Agents

Recently, LLM-based agents have become increasingly popular across many applications, including complex sequential decision-making problems. However, they inherit the tendency of LLMs to hallucinate, leading to incorrect decisions. In sequential settings, even a single mistake can irreversibly degrade the trajectory, making hallucinations an even bigger problem. Although larger LLMs hallucinate less, they incur a significantly higher per-token cost. In this paper, we address this tradeoff by proposing ReDAct (Reason-Defer-Act). In ReDAct, an agent is equipped with two LLMs: a small, cheap model used by default, and a large, more reliable but expensive model. When the predictive uncertainty of the small model exceeds a calibrated threshold, the decision is deferred to the large model. We evaluate our approach in text-based embodied environments such as ALFWorld and MiniGrid and show that deferring only about 15% of decisions to the large model can match the quality of using it exclusively, while significantly reducing inference costs.