The Advanced Research Projects Agency for Health (ARPA-H) has awarded contracts in its Agentic AI-EnableD CardioVascular CAre TransfOrmation (ADVOCATE) program whose goal is to create a reliable, FDA-authorized clinical agentic AI system that serves as a digital member of the clinical care team. 

ARPA-H’s commitment is up to $33.7 million in the first year of the four-year, $62.7 million program. If successful, ARPA-H estimates, ADVOCATE will save lives, reduce preventable hospitalizations, and generate an estimated $28 billion in annual cost savings across the heart failure population alone. 

Here are descriptions of the teams chosen and their areas of research:

TA1: Patient-Facing Clinical AI Agent 
These teams will develop a patient-facing clinical AI agentic system capable of autonomously supporting patients with heart failure between healthcare visits and escalating to the human care team as a new autonomous member of the clinical team. 
Atman Health: The team will develop a clinical AI agentic system built on evidence-based clinical decision engine. Large language models (LLMs) with a voice-first interface that patients talk to, and the system adjusts on the fly to ask each patient the diagnostic questions most likely to be useful. 
Tempus AI: The team will develop a clinical AI agentic system extending their existing Olivia patient health app, adding continuous monitoring with deeper clinical analysis when it detects meaningful changes in a patient’s health. 
UpDoc: The team will develop a clinical AI agentic system whose conversational intelligence is separated from clinical authority by a clinician-built rules system that validates every proposed action against approved protocols before execution. The UpDoc team includes OpenAI, Microsoft and NVIDIA. UpDoc was selected in part because it already has FDA clearance for a software medical device using a patient-facing LLM and has been developing highly guardrailed autonomous clinical AI for use within provider EHR workflows.

TA2: Supervisory AI Agent 
This team will design and build the disease-agnostic supervisory AI system that continuously monitors the TA1 clinical agents after successful deployment. This includes detecting unsafe recommendations, and out-of-distribution behavior in real time — providing an ongoing assurance layer that the FDA, health systems, patients, and clinicians can trust. 

Stanford University: The team will develop a supervisory system using a three-stage, compute-escalating pipeline — outlier filtering, rule-based screening, and a deep-research auditing agent — that produces inspectable per-claim rationales. 


ADVOCATE's TA1 must submit a first-of-its-kind FDA-authorization package for this product within 24-months of contract award. Performers across both areas will work closely together to develop technical interfaces, safety benchmarks, and evaluation protocols throughout the program. 

TA3: Scalable Implementation in Health Systems 
These teams, anchored in prominent health systems, will design and execute the real-world implementation strategy that brings ADVOCATE technology to patients and clinicians across diverse care settings, with a particular focus on rural and underserved communities where cardiology access is most constrained. 

Duke University: The team will provide a multi-site validation platform testing ADVOCATE agents across five health systems and rural sites on both Epic and Cerner/Oracle electronic health records (EHRs), amplified by the American Heart Association’s national reach. 
Kaiser Permanente: The team will provide an enterprise-scale deployment across 21 medical centers and 260+ clinics, embedding ADVOCATE agents into Epic (EHR) software workflows for heart failure patients and generating reusable deployment blueprints via shadow-mode deployments and pragmatic randomized clinical trials. 

ARPA-H says that ADVOCATE could develop a pathway for agentic AI to emerge as a new autonomous member of the clinical team, for every patient with every condition.

Speaking at a recent meeting of the NIH Collaboratory Grand Rounds, ADVOCATE Program Manager Haider Warraich, M.D., a practicing cardiologist, discussed the ambitious nature of the ARPA-H effort. He said that in addition to low-risk functions, such as helping with care navigation, setting up appointments, and estimating costs, they also want to focus on higher-risk functions. “These include making treatment recommendations based on the patient's prompts, but also the patient's data from the electronic health record, being able to provide a diagnosis and perform triage. Triage is going to be one of the really important functions of these technologies, and you can't really do triage unless you can make a diagnosis,” he said. “We really want to specifically focus on things that are unambiguously high-risk. We're really focused on being able to change or renew or refill existing prescriptions, or even write new prescriptions. And the prescriptions that you would focus on for the purposes of this program are going to be what we describe as in scope to the primary indication, which in this case is patients with heart failure. In-scope medications would be either guideline-directed medical therapy for heart failure or diuretic management.”