Key result
Digital twins and agent-based models for heart failure remain investigational without routine clinical adoption.
Why the study?
The clinical maturity and implementation barriers of agent-based models, discrete-event simulation, and digital twins in heart failure care remain uncertain.
Digital twins and agent-based simulation models for heart failure remain investigational and require extensive prospective validation and workflow integration before clinical implementation.
Clinical maturity of ABM, DES, and DT for HF care remains uncertain; leaves open their role in service design pending prospective validation.
Heart failure (HF) requires coordinated care across home, ambulatory, emergency, inpatient and hospital-at-home settings. Agent-based models (ABM), discrete-event simulation (DES) and digital twins (DT) have been proposed to support service design and individualized decisions, but their clinical maturity is uncertain. We performed a narrative review, updated through 31 July 2026, separating established clinical evidence for HF care models from HF-specific computational evidence and extrapolated cardiovascular DT literature. The evidence map includes nine representative HF-specific computational studies: four agent-based or hybrid systems, one DES model and four DT-oriented studies. Most were conceptual, simulation-based, retrospective or proof-of-concept; only a small number included external or invasive-reference validation, and none established routine DT-guided clinical care. Current evidence supports ABM/DES mainly for hypothesis generation and service design. HF digital twins remain investigational. Prospective validation, interoperability, recalibration, cybersecurity, workflow integration, cost-effectiveness and digital equity are prerequisites before clinical implementation.
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Epelde et al. (2026) conducted a review in Heart failure. Agent-based models, discrete-event simulation, and digital twins was evaluated on Clinical maturity and implementation. A review of nine representative computational studies found that agent-based models and digital twins for heart failure care remain investigational, with none establishing routine clinical care.
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