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01.
arXiv (CS.AI) 2026-06-11

When Researchers Say Mental Model/Theory of Mind of AI, What Are They Really Talking About?

arXiv:2510.02660v2 Announce Type: replace-cross Abstract: When researchers claim AI systems possess ToM or mental models, they are fundamentally discussing behavioral predictions and bias corrections rather than genuine mental states. This position paper argues that the current discourse conflates sophisticated pattern matching with authentic cognition, missing a crucial distinction between simulation and experience. While recent studies show LLMs achieving human-level performance on ToM laboratory tasks, these results are based only on behavioral mimicry. More importantly, the entire testing paradigm may be flawed in applying individual human cognitive tests to AI systems, but assessing human cognition directly in the moment of human-AI interaction. I suggest shifting focus toward mutual ToM frameworks that acknowledge the simultaneous contributions of human cognition and AI algorithms, emphasizing the interaction dynamics, instead of testing AI in isolation.

02.
arXiv (CS.CL) 2026-06-19

CATCH-ME if you RAG: a dataset of Contextually Annotated multi-Turn Counterspeech against Hate and Misinformation Exchanges

Online hate speech and misinformation frequently overlap, yet NLP research has mainly treated them in isolation. While LLMs represent a scalable solution for assisting humans in the generation of counterspeech for both threats, zero-shot models frequently generate repetitive and vague responses, underscoring the need for high-quality examples to steer model generation. However, existing counterspeech datasets against the overlap of hate and misinformation are scarce and limited to single-turn English dialogues, while real-life interactions span across multiple turns and languages. To bridge this gap, we introduce the first large-scale, expert-curated, multilingual dataset of dialogues tackling the intersection of hate and misinformation. To ensure factual grounding, the dialogues are also anchored in verified external knowledge (i.e., fact-checking articles and NGO reports) and include document- and chunk-level span annotations, making it directly applicable for RAG systems. Covering five languages and targeting hate directed at seven marginalized groups, this novel resource enables the training and evaluation of more persuasive, factually grounded counterspeech models.

03.
arXiv (CS.AI) 2026-06-15

PRISM: Perception Reasoning Interleaved for Sequential Decision Making

arXiv:2605.05407v2 Announce Type: replace Abstract: Scaling LLM-based embodied agents from text-only environments to complex multimodal settings remains a major challenge. Recent work identifies a perception-reasoning-decision gap in standalone Vision-Language Models (VLMs), which often overlook task-critical information. In this paper, we introduce PRISM, a framework that tightly couples perception (VLM) and decision (LLM) through a dynamic question-answer (DQA) pipeline. Instead of passively accepting the VLM's description, the LLM critiques it, probes the VLM with goal-oriented questions, and synthesizes a compact image description. This closed-loop interaction yields a sharp, task-driven understanding of the scene. We evaluate PRISM on the ALFWorld and Room-to-Room (R2R) benchmarks. We show that: (1) PRISM significantly outperforms state-of-the-art image-based models, (2) our Interactive goal-oriented perception pipeline yields systematic and substantial gains, and (3) PRISM is fully automatic, eliminating the need for handcrafted questions or answers.

04.
arXiv (math.PR) 2026-06-25

Dragon curves in Littlewood roots

arXiv:2606.25440v1 Announce Type: cross Abstract: A Littlewood polynomial is a polynomial whose coefficients lie in $\{- 1, +1\}$. While the majority of roots of a Littlewood polynomial of large degree are near the unit circle, numerical experiments suggest that when plotting the roots of all Littlewood polynomials of a given large degree, striking fractal structures appear away from the unit circle. These fractals resemble the attractor of a certain iterated function system and are known as dragon curves. In this note, we provide a rigorous explanation of this phenomenon, along with an analysis of a random variant, saying that such fractal behavior is typical.

05.
arXiv (CS.AI) 2026-06-16

Consensus-based Agentic Large Language Model Framework for Harmonized Tariff Schedule Code Classification

arXiv:2606.16987v1 Announce Type: new Abstract: Accurate Harmonized Tariff Schedule (HTS) code classification is essential for customs clearance, duty assessment, trade statistics, and regulatory compliance in maritime logistics. However, exact HTS classification remains challenging because product descriptions are often short, incomplete, or ambiguous, while correct classification depends on hierarchical tariff structures, legal notes, and jurisdiction-specific rules. This paper proposes an agentic large language model (LLM) framework for Canadian 10-digit HTS code classification in smart-port and maritime logistics environments. The framework integrates multi-agent information retrieval, semantic retrieval over official tariff documents, evidence-grounded reasoning, consensus-based validation, element-wise voting across hierarchical code components, confidence estimation, and human-in-the-loop escalation. We evaluate the framework on a private dataset of 3,300 domain-expert-labeled product records collected from logistics and delivery contexts. Experimental results show that exact 10-digit classification remains difficult even for advanced LLMs, with performance decreasing from coarse chapter-level prediction to fine-grained tariff and statistical suffix assignment. These findings demonstrate the need for evidence-grounded, uncertainty-aware, and human-centered classification workflows rather than fully autonomous single-step prediction. The proposed framework supports more interpretable, accountable, and compliance-oriented HTS classification for maritime logistics and smart-port operations. Our code is available at https://github.com/Analytics-Everywhere-Lab/hts.

06.
arXiv (CS.AI) 2026-06-24

Uncertainty-Aware Longitudinal Forecasting of Alzheimer's Disease Progression Using Deep Learning

arXiv:2606.24604v1 Announce Type: new Abstract: Longitudinal modelling of Alzheimer's disease progression is clinically useful only if it can describe not just the most likely next diagnosis, but how a patient may evolve over time and how reliable that forecast is. Most deep learning approaches reduce this problem to single-step classification, treating cognitively normal, mild cognitive impairment, and dementia as flat categories while providing limited insight into how uncertainty accumulates across future visits. We propose a probabilistic framework that combines ordinal diagnosis prediction, multi-horizon trajectory generation, and decomposed uncertainty estimation. A Temporal Fusion Transformer encoder is adapted with a CORAL ordinal output layer, asymmetric loss weighting, and converter oversampling to respect disease-stage ordering and improve sensitivity to MCI-to-dementia transitions. Conditioned on the learned patient-context representation, an autoregressive Mixture Density Network generates five-year probabilistic trajectories for diagnosis state, CDR Sum of Boxes, MMSE orientation, and hippocampal volume. On ADNI, the model outperforms linear, recurrent, and transformer baselines for next-visit diagnosis prediction, with the strongest gains on MCI-versus-dementia discrimination. Generated trajectories achieve near-nominal 90% credible interval coverage, widening uncertainty across the forecast horizon, and biomarker dynamics consistent with expected Alzheimer's disease progression. We further separate aleatoric from epistemic uncertainty using analytic mixture variance and a five-member bootstrap ensemble, which provides the strongest encoder diversity and output-level epistemic signal. Epistemic uncertainty is higher for rare progression archetypes, MCI and dementia patients, and under external evaluation on OASIS-3, where it increases alongside prediction error.

07.
arXiv (CS.LG) 2026-06-19

The Hidden Cost of Approximation in Online Mirror Descent

arXiv:2511.22283v2 Announce Type: replace Abstract: Online mirror descent (OMD) is a fundamental algorithmic paradigm that underlies many algorithms in optimization, machine learning and sequential decision-making. The OMD iterates are defined as solutions to optimization subproblems which, oftentimes, can be solved only approximately, leading to an inexact version of the algorithm. Nonetheless, existing OMD analyses typically assume an idealized error free setting, thereby limiting our understanding of performance guarantees that should be expected in practice. In this work we initiate a systematic study into inexact OMD, and uncover an intricate relation between regularizer smoothness and robustness to approximation errors. When the regularizer is uniformly smooth, we establish a tight bound on the excess regret due to errors. Then, for barrier regularizers over the simplex and its subsets, we identify a sharp separation: negative entropy requires exponentially small errors to avoid linear regret, whereas log-barrier and Tsallis regularizers remain robust even when the errors are only polynomial. Finally, we show that when the losses are stochastic and the domain is the simplex, negative entropy regains robustness-but this property does not extend to all subsets, where exponentially small errors are again necessary to avoid suboptimal regret.

08.
arXiv (CS.AI) 2026-06-25

Communicability-Inspired Positional Encoding (CIPE)

arXiv:2606.25293v1 Announce Type: cross Abstract: Positional encodings (PEs) are essential for Transformers. Yet designing effective PEs for non-Euclidean graphs remains challenging. Such encodings should ideally induce an Attention-Compatible Geometry for self-attention: not merely describing graph structure, but defining a geometry whose inner products reflect meaningful structural relatedness. To realize this geometry, we propose Communicability-Inspired Positional Encoding (CIPE), built from communicability, a measure between pairs of nodes that aggregates contributions from paths of all lengths. By construction, CIPE inner products recover communicability, converting global multi-path connectivity into an attention-ready similarity geometry. For practical Transformer training, we introduce dimensionality alignment, mapping graph-size-dependent CIPE representations to prescribed dimensions while faithfully preserving the induced geometry. Empirically, CIPE improves structure-agnostic Transformers by 35.5% on average across seven benchmarks, outperforming representative PEs; it also consistently improves structure-biased graph Transformers, where competing PEs often yield only marginal benefits. These results position CIPE as a principled framework for attention-compatible graph positional encodings.

09.
arXiv (math.PR) 2026-06-17

Order statistics for edge eigenvectors of Wigner matrices

arXiv:2606.17425v1 Announce Type: new Abstract: In this paper, we establish a general comparison theorem for the order statistics of the edge eigenvectors for generalized Wigner matrices. Consequently, we derive the Gumbel law for the maximal edge eigenvector component and prove the universality of the Gaussian fluctuations of the order statistics in an intermediate regime close to the maximum. In addition, our comparison result also implies a quantitative first order estimate for moderately small order statistics.

10.
PLOS Medicine 2026-05-13

On the evolution of the company we keep: Implications for infectious disease modeling

Authors:

by Joël Mossong Whom we meet shapes how infections spread. Where earlier focus of mathematical epidemiology was on incorporating age, more recent work has begun to reveal the importance of socioeconomic aspects for understanding and managing future epidemics. In this Perspective, Joël Mossong discusses the importance of understanding social contacts and how they have evolved for infectious disease modeling, and the need to factor in additional considerations such as ethic and socioeconomic backgrounds.

11.
arXiv (CS.LG) 2026-06-12

Policy-driven Conformal Prediction for Trustworthy QoT Estimation

arXiv:2606.12501v1 Announce Type: new Abstract: We propose Conformal QoT, a policy-driven framework that combines statistically guaranteed QoT estimation with operational decision policies, enabling reliable lightpath-feasibility predictions under domain shift and improving accuracy from 92\% to 99.6\% on open datasets.

12.
arXiv (math.PR) 2026-06-19

An alternative approach to well-posedness of McKean-Vlasov equations arising in Consensus-Based Optimization

arXiv:2512.19446v4 Announce Type: replace-cross Abstract: In this work we study the mean-field description of Consensus-Based Optimization (CBO), a derivative-free particle optimization method. Such a description is provided by a non-local SDE of McKean-Vlasov type, whose fields lack of global Lipschitz continuity. We propose a novel approach to prove the well-posedness of the mean-field CBO equation based on a truncation argument. The latter is performed through the introduction of a cut-off function, defined on the space of probability measures, acting on the fields. This procedure allows us to study the well-posedness problem in the classical framework of Sznitman. Through this argument, we recover the established result on the existence of strong solutions, and we extend the class of solutions for which pathwise uniqueness holds.

13.
arXiv (CS.CL) 2026-06-16

OBCache: Optimal Brain KV Cache Pruning for Efficient Long-Context LLM Inference

Large language models (LLMs) with extended context windows enable powerful applications but impose significant memory overhead, as caching all key-value (KV) states scales linearly with sequence length and batch size. Existing cache eviction methods address this by exploiting attention sparsity, yet they typically rank tokens heuristically using accumulated attention weights without considering their true impact on attention outputs. We propose Optimal Brain Cache (OBCache), a principled framework that formulates cache eviction as a layer-wise structured pruning problem. Building upon the Optimal Brain Damage (OBD) theory, OBCache quantifies token saliency by measuring the perturbation in attention outputs induced by pruning tokens, with closed-form scores derived for isolated keys, isolated values, and joint key-value pairs. Our scores account not only for attention weights but also for information from value states and attention outputs, thereby enhancing existing eviction strategies with output-aware signals. Experiments on LLaMA and Qwen models demonstrate that replacing the heuristic scores in existing works, which estimate token saliency across different query positions, with OBCache's output-aware scores consistently improves long-context accuracy. Code is available at https://github.com/DreamSoul-AI/OBCache.

14.
arXiv (CS.CL) 2026-06-19

Disentangling Linguistic Relatedness from Task Alignment in Cross-Lingual Transfer

We study cross-lingual transfer by fine-tuning seven large language models (4B–671B parameters) on Arabic and evaluating zero-shot reading comprehension on Semitic languages and non-Semitic controls. Across dense and Mixture-of-Experts architectures, we find no evidence of Semitic-specific transfer: models with weak baselines improve dramatically across all languages, while strong-baseline models show only marginal gains regardless of language family. A chain-of-thought ablation reinforces this finding – the same models that benefit most from fine-tuning benefit equally from inference-time reasoning, suggesting both mechanisms address task-format alignment rather than cross-lingual knowledge transfer.

15.
arXiv (CS.AI) 2026-06-16

FOUNDv2: Learning Unified User Quantized Tokenizers for User Representation

arXiv:2508.00956v3 Announce Type: replace-cross Abstract: User representation learning serves as a fundamental pillar for personalized services on large-scale web platforms. Despite its importance, conventional continuous embedding methods face significant challenges, including the lack of a unified paradigm for multi-source data integration, prohibitive storage overhead due to low information density, and the lack of multi-scale modeling granularity. To overcome these limitations, we introduce FOUNDv2, a comprehensive user representation scheme centered on the Unified User Quantized Tokenizer U2QT) framework. FOUNDv2 transforms heterogeneous user data into a standardized discrete token space through a robust two-stage architecture. Specifically, the framework first extracts compact feature representations and subsequently employs a multi-view RQ-VAE to discretize them into storage-efficient tokens using shared and source-specific codebooks. To empower these representations with predictive intelligence, we further design multi-scale alignment objectives to capture both fine-grained behavioral dependencies and macro-temporal periodicity. Extensive experiments on various benchmarks demonstrate that FOUNDv2 consistently outperforms task-specific baselines while achieving substantial reductions in storage and computational costs. Finally, the large-scale deployment of FOUNDv2 on Alipay validates its practical scalability and efficiency across diverse industrial scenarios. The main code is available at: https://github.com/chuanhe1999/FOUNDv2.

16.
arXiv (CS.AI) 2026-06-11

\texttt{Range-Arithmetic}: Verifiable Deep Learning Inference on an Untrusted Party

arXiv:2505.17623v2 Announce Type: replace-cross Abstract: Verifiable computing (VC) has gained prominence in decentralized machine learning systems, where resource-intensive tasks like deep neural network (DNN) inference are offloaded to external participants due to blockchain limitations. This creates a need to verify the correctness of outsourced computations without re-execution. We propose \texttt{Range-Arithmetic}, a novel framework for efficient and verifiable DNN inference that transforms non-arithmetic operations, such as rounding after fixed-point matrix multiplication and ReLU, into arithmetic steps verifiable using sum-check protocols and concatenated range proofs. Our approach avoids the complexity of Boolean encoding, high-degree polynomials, and large lookup tables while remaining compatible with finite-field-based proof systems. Experimental results show that our method not only matches the performance of existing approaches, but also reduces the computational cost of verifying the results, the computational effort required from the untrusted party performing the DNN inference, and the communication overhead between the two sides.

17.
arXiv (CS.CL) 2026-06-25

Evaluating LLMs on Real-World Software Performance Optimization

Software performance optimization is a notoriously complex and manual task. Despite the growing use of Large Language Models (LLMs) for code refinement, we still lack benchmarks that capture how optimization actually happens in real-world codebases. Existing frameworks often oversimplify the problem by focusing on isolated functions or a single performance metric, missing the critical trade-offs between execution time and memory footprint, the inherent noise of the measurement environment, and the variability introduced by different input data and execution conditions. We address this by introducing SWE-Pro, a repository-level benchmark derived from 102 expert-written optimizations from open-source projects. Unlike previous benchmarks, SWE-Pro pairs each task with parameterized tests to evaluate runtime, peak memory, and Time-Weighted Memory Usage (TWMU) across varying input data and execution conditions under noise-aware measurement conditions. Our evaluation shows that current LLMs struggle significantly: runtime gains are negligible, and memory optimizations are nearly non-existent. This stands in sharp contrast to expert implementations, which achieve an aggregate speedup of 15.5x and peak memory reduction of 171.3x over benchmark tasks. Expert-written improvements are observed in 91.2% of tasks for runtime and 65.7% for peak memory. Our findings expose a substantial gap between current LLM capabilities and the demands of expert-level engineering.

18.
arXiv (CS.CL) 2026-06-16

Weaving Multi-Source Evidence for Biomedical Reasoning: The BioMedHop Benchmark and BioWeave Framework

Biomedical question answering (QA) increasingly requires reasoning over interacting entities, where supporting evidence is scattered across biomedical knowledge graphs, literature documents, and web-accessible resources. However, existing biomedical QA benchmarks mainly focus on exam-style knowledge, literature comprehension, or short-range multi-hop inference, leaving source-conditioned graph reasoning and evidence topology construction underexplored. To fill this gap, we introduce BioMedHop, a multi-source graph-grounded benchmark for evaluating biomedical reasoning over structured evidence topologies. BioMedHop contains 10,045 instances across KG, document, web, and hybrid evidence settings, covering shared-neighbor matching, intersection reasoning, path-based reasoning, and counting, with option-based, open-ended, and numeric count renderings. To support this benchmark, we further propose BioWeave, a source-aware reasoning framework that retrieves biomedical KG paths, gathers supporting clues from documents and web sources, assembles them into a unified evidence graph, and verifies answers through entity-level evidence support. Comprehensive experiments show that BioWeave achieves the best overall performance among compared methods on BioMedHop, outperforming the strong hybrid baseline ToG-2 by 10.5% in the overall average. Moreover, BioWeave consistently improves different LLM backbones and enables smaller models, such as Qwen3-4B, to achieve reasoning performance comparable to GPT-4-Turbo.

19.
arXiv (CS.AI) 2026-06-11

Are Frontier LLMs Ready for Cybersecurity? Evidence for Vertical Foundation Models from Dual-Mode Vulnerability Benchmarks

arXiv:2605.23243v2 Announce Type: replace-cross Abstract: We evaluate whether frontier LLMs are ready for cybersecurity through a dual-mode benchmark: white-box function-level vulnerability detection (VulnLLM-R, across C/Java/Python) and black-box web application security testing (five production-style applications with 118 ground-truth vulnerabilities across 20+ CWE families, which we will open-source). We test six frontier models (GPT-5.4, Codex~5.3, Claude Opus~4.6, Sonnet~4.6, Gemini~3.1~Pro and Gemini~3~Flash) and two domain-specialized models across four testing paradigms. Our findings are sobering: (1)~every frontier model produces 10-50% false positive rates in white-box detection, systematically over-predicting vulnerabilities; (2)~in black-box testing, frontier models achieve only 4-8% ground-truth coverage, improving to just 10-19% even with external security tools (Playwright MCP, Burp Suite MCP); (3)~structured penetration-testing methodology encoded in domain-specialized agents raises per-family detection above 50%, demonstrating that methodology, not scale, is the primary lever; and (4)~a domain-specialized defense model achieves the highest precision (0.904) and lowest false positive rate (9.7%) among all models, on a single GPU. We identify the absence of structured security testing traces end-to-end request/response sequences, failure-heavy data, and multi-step attack chains as the fundamental training data bottleneck, and propose self-play security testing as a data generation strategy. Our results make the case for vertical foundation models purpose-built for cybersecurity.

20.
arXiv (CS.CL) 2026-06-19

The Voice Behind the Words: Quantifying Intersectional Bias in SpeechLLMs

Speech Large Language Models (SpeechLLMs) process spoken input directly, retaining cues such as accent and perceived gender that were previously removed in cascaded pipelines. This introduces speaker identity dependent variation in responses. We present a large-scale intersectional evaluation of accent and gender bias in three SpeechLLMs using 2,880 controlled interactions across six English accents and two gender presentations, keeping linguistic content constant through voice cloning. Using pointwise LLM-judge ratings, pairwise comparisons, and Best-Worst Scaling with human validation, we detect recurring directional disparities. Eastern European-accented speech receives lower helpfulness scores, particularly for female-presenting voices. Responses remain polite but differ in helpfulness. While LLM judges capture the directional trend of these biases, human evaluators exhibit significantly higher sensitivity, showing stronger accent-level contrasts.

21.
arXiv (CS.CV) 2026-06-17

Graph Neural Networks for Semi-Supervised Image Classification with Multi-Feature Aggregation

Feature extraction involves the identification and extraction of salient characteristics or patterns, including edges, textures, shapes, and color attributes. Contemporary feature extractors predominantly leverage deep learning architectures, such as Convolutional Neural Networks (CNNs) and Vision Transformers (VITs). The availability of diverse feature extractors in the literature provides a wide range of feature representations. Features extracted from an image depend on the specific application, the chosen extractor, and its configuration. Therefore, integrating complementary information by combining distinct extractors offers a promising way to enhance performance. Graph Neural Networks (GNNs), particularly Graph Convolutional Networks (GCNs), have emerged as powerful and widely adopted approaches for semi-supervised image classification, as they effectively leverage both labeled and unlabeled data while exploiting the underlying graph structures that capture relationships among samples. This study proposes a novel approach for GNNs in scenarios where labeled data is scarce, by integrating diverse sets of feature and graph representations derived from various extractors in classification scenarios. Experimental investigations were conducted, encompassing combinations of distinct feature and graph extractors, as well as rank aggregation strategies. The primary contributions of this work are underscored by the experimental findings, which demonstrate that the strategic combination of feature and graph representations, coupled with the application of manifold learning for graph processing, leads to significant improvements in classification accuracy across the majority of experimental conditions. Furthermore, the utilization of rank aggregation techniques to integrate features from different extractors was shown to enhance classification accuracy.

22.
arXiv (CS.CV) 2026-06-17

Revisiting LLM Adaptation for 3D CT Report Generation: A Study of Scaling and Diagnostic Priors

Recent advances in multimodal learning, including large language models (LLMs) and vision-language models (VLMs), have demonstrated strong adaptability to natural images. However, extending their use to the medical domain, particularly for volumetric (3D) images, is challenging due to high computational complexity, volumetric dependencies and the semantic gap between visual features and clinical terminology. Naively fine-tuning LLMs on limited medical data often leads to overfitting and clinical hallucination, where linguistic fluency is prioritized over clinical factuality. In this study, we investigate parameter-efficient adaptation strategies for volumetric CT report generation and introduce RAD3D-Prefix, a lightweight diagnostic-prior conditioning framework that minimizes the need for extensive parameter training. This module integrates image embeddings with multi-label diagnostic classification logits, preserving critical clinical details while bridging the semantic gap. By keeping the LLM frozen, our method requires minimal trainable parameters and mitigates the risk of overfitting on small, domain-specific datasets. Through a systematic study spanning LLMs from 96.1M to 1.6B parameters, we find that fine-tuning is most beneficial for smaller LLMs, whereas freezing larger (~1B+ LLMs and training only lightweight projection layers provides a superior trade-off between performance, generalization, and computational efficiency. Across multiple automatic metrics and a clinical reader study, RAD3D-Prefix outperforms comparable parameter-efficient baselines and demonstrates strong out-of-domain generalization while using substantially fewer trainable parameters than fully fine-tuned alternatives.

23.
arXiv (CS.AI) 2026-06-24

Beyond U-Net: A Latent-Representation-Aligned Skip-Free Backbone for Flow-Matching Speech Enhancement

arXiv:2606.24745v1 Announce Type: cross Abstract: Generative models, particularly diffusion and score-based approaches, have recently achieved strong performance in speech enhancement, but their iterative sampling process limits real-time deployment. Flow Matching offers an efficient alternative by transporting noisy speech toward clean speech through an ordinary differential equation with few function evaluations. In this work, we propose a skip-free encoder-decoder backbone for flow-matching speech enhancement, guided by Latent Representation Alignment (LRA). Instead of relying on U-Net skip connections, which may transfer noise-correlated low-level features to the decoder, the proposed model aligns its bottleneck and decoder representations with clean latent features extracted from a frozen Descript Audio Codec encoder-decoder without quantization. This codec-aligned supervision promotes compact clean-speech representations while preserving efficient few-step inference. Experiments on WSJ0-CHiME3 and VoiceBank-DEMAND show improved PESQ and perceptual quality, especially on VoiceBank-DEMAND, using only five function evaluations.

24.
PLOS Medicine 2026-06-23

Comparisons of core component delivery in cardiac rehabilitation programs by country income classification and decade based on the 2025 Global Audit Update: A survey study

by Gabriela Lima de Melo Ghisi, Rachael P. Carson, Karam Turk Adawi, Rongjing Ding, Warner M. Mampuya, Mariya P. Jiandani, Jimena Martinez, Monserrat Cruz Rivero, Claudia V. Anchique, Dinah L. van Schalkwijk, Jonathan Gallagher, Buket Akinci, Dion Candelaria, Jirapa Champaiboon, Daniel F. Quesada-Chaves, Tone M. Norekvål, Iwona Szadkowska, Borut Jug, Evangelia Kouidi, Marta Supervia, Won-Seok Kim, Chamila Mettananda, Lilian Mbau, Gulsim T. Aimakova, Sherry L. Grace, on behalf of the ICCPR Global Cardiac Rehabilitation Audit Update Investigators Background Cardiovascular disease (CVD) remains a leading global health burden. Cardiac rehabilitation (CR) is essential to reducing morbidity and improving patient outcomes. Since the COVID-19 pandemic, CR delivery worldwide has evolved, yet these changes have not been systematically charactemkjrized. The objective of this study was to characterize globally: (1) the delivery of core CR components, including risk factors assessed, patient education practices, and program resources; (2) differences in these elements by country income classification and relative to the initial 2016 Global CR Audit. Methods and findings A cross-sectional Audit update was conducted. Program-level data were collected from May 1st to September 1st 2025 using a REDCap survey adapted from previous Audits. Eligible respondents were leads of phase II/post-discharge CR programs providing at least an initial assessment, structured aerobic exercise, and ≥1 additional core component. ICCPR associations and local leaders supported program identification. Main outcomes were core components delivered (10 assessed), risk factors assessed (14 assessed), patient education dose (hours/patient/program), and program resources (17 assessed). Generalized linear mixed models (GLMM) tested differences by income classification and (when applicable) changes since 2016. Of 7,025 programs identified globally, 1,505 (62% median country response rate) initiated a survey from 90/113 (80%) countries with CR. The median number of core components offered was 8/program (p25, p75 = 6, 10), with upper-middle income countries offering significantly more components overall (median = 9), and also high-income countries offering more than low-income countries (8 versus 6, p