Multivariate multi-horizon time-series forecasting for real-time patient monitoring based on cascaded fine tuning of attention-based models

The real-time forecasting of critical physiological indicators in intensive care units (ICUs) is essential for early intervention and clinical decision support. This study introduces a novel framework, StreamHealth Multi-Horizon AI, which has been designed to perform multivariate, multi-horizon time-series forecasting for vital signs, specifically for a person's blood oxygen saturation level (SpO2) and respiratory rate (RR). The framework leverages advanced attention-based models, with a particular emphasis on the Temporal Fusion Transformer (TFT) and Temporal Convolutional Network (TCN), and we benchmark its performance against classical deep learning architectures, including LSTM, GRU, Bi-LSTM, Bi-GRU, CNN, and Sequence-to-Sequence (Seq2Seq) models with and without attention mechanisms. Both univariate and multivariate forecasting tasks are explored across multiple prediction horizons (i.e., 7, 15 and 25 min), using physiological time-series data from the MIMIC-III database. The proposed system incorporates a cascaded fine-tuning strategy, wherein the TFT model is sequentially fine-tuned on individual patients' data, significantly enhancing the model's generalizability to unseen patient profiles. Empirical results demonstrate that the TFT model consistently outperforms baseline models across all forecasting settings, achieving lower RMSE and MAE values, and exhibiting superior capacity for capturing long-sequence dependencies and temporal feature dynamics. To validate its applicability in real-time clinical environments, the framework integrates a simulated streaming infrastructure using Apache Kafka and Apache Flink, enabling continuous data ingestion, forecasting, and visualization of vital signs. This end-to-end deployment underscores the system's potential for ICU monitoring, allowing clinicians to anticipate patient deterioration proactively. In summary, we introduce a comprehensive framework that uniquely integrates TFT with cascaded fine-tuning for multivariate, multi-horizon forecasting of critical ICU indicators. Additionally, we demonstrate a simulation for a real-time deployment pipeline using Kafka and Flink, enabling robust and generalizable ICU monitoring in clinical settings. As a result, this work has contributed a robust and clinically relevant AI solution for real-time healthcare monitoring.