CAP: Towards PPG Universal Representation Learning with Patient-level Supervision

Photoplethysmography (PPG), a non-invasive measure of changes in blood volume, is widely used in both wearable devices and clinical settings. Recent PPG foundation models either use open-source ICU datasets with pretraining paradigms that require curated data and thus complicate generalization to field-like data, or use closed-source field-like PPG data. In contrast, we propose a PPG foundation model that does not require high-quality or field-like pretraining data, and instead leverages accompanying electrocardiogram and respiratory signals in ICU datasets to select contrastive samples during pretraining. Our approach allows the model to retain and learn from noisy PPG segments, improving robustness at inference. Our model, pretrained on 3x fewer subjects than existing state-of-the-art approaches, achieves performance improvements on 14 out of 15 diverse downstream tasks, including field-like daily activity and heart rate prediction. Our results demonstrate that multimodal supervision can integrate complementary physiological information to improve the robustness of PPG foundation models and enhance their generalization to consumer-grade data.

Cardiovascular disease remains the leading cause of global mortality, yet scalable cardiac monitoring is hindered by the gap between diagnostic-rich ECG and ubiquitous wearable PPG. Bridging this gap requires representations that are compact, transferable across modalities and devices, and deployable without task-specific retraining. Here we introduce biosignal fingerprints: compact latent representations of cardiovascular state derived from a cross-modal foundation model, the Multi-modal Masked Autoencoder (M2AE), trained on over 3.4 million paired ECG and PPG signals. M2AE integrates modality-specific encoders with a shared bottleneck and dual decoders, jointly optimized using reconstruction and cross-modal contrastive objectives, yielding generalizable fingerprints that retain intra- and inter-modality features. Like a biometric fingerprint, these representations uniquely encode an individual's cardiovascular state in a modality-agnostic, privacy-preserving form reusable across clinical tasks without exposing raw waveform data or requiring model retraining. Across 7 downstream tasks, spanning cross-modal reconstruction, cardiovascular disease classification, hypertension detection, mortality prediction, and demographic inference, biosignal fingerprints achieve competitive or superior performance compared to leading domain-specialist foundation models in frozen settings, including an AUROC of 0.974 for five-class CVD classification and 0.877 for hypertension detection, with a maximum improvement of 27.7% in AUROC across 5 classification tasks. Critically, strong performance is maintained with only a single modality, enabling deployment in resource-constrained, single-sensor environments typical of real-world wearable monitoring, with direct implications for continuous cardiovascular monitoring across clinical and consumer health settings.

Wearables are widely used for mobile health monitoring, and photoplethysmography (PPG) is a key sensing modality for heart rate and related physiological measurements. However, public in-the-wild PPG datasets remain largely wrist-centric or limited to short, controlled studies, constraining research on emerging wearable form factors. We present Multi-site PPG, an in-the-wild physiological dataset collected from four custom-developed unobtrusive wearables: a smart earring, ring, watch, and necklace. Each device records green and infrared reflective PPG, 3-axis acceleration, and temperature with timestamps for cross-device alignment, while a Polar H10 chest strap provides reference electrocardiogram (ECG). Participants wore the devices for multiple days during daytime activities while continuing their normal routines. The dataset contains over 350 hours of raw data and 230-290 hours of modeling-ready 8-second windows per wearable. We benchmark heuristic, supervised, and self-supervised heart-rate estimation methods, showing substantial body-site differences: the best methods achieve mean absolute errors (MAEs) of 2.30 bpm on the earring, 5.13 bpm on the ring, 8.37 bpm on the watch, and 8.68 bpm on the necklace. We further analyze motion effects and evaluate multi-site and PPG-accelerometer fusion, demonstrating the dataset's value for robust physiological sensing across emerging wearable form factors.