ECG foundation models share an age-related performance disparity that originates in the data, not the models

Background. Electrocardiogram (ECG) foundation models are proposed for clinical use and promoted as fair, yet such claims are rarely tested with subgroup-stratified evaluation. We measured demographic disparities across four ECG foundation models, tested whether mitigation removes them, and asked whether the dominant disparity originates in the models or in the data and the clinical task. Methods. We probed frozen embeddings of four architecturally distinct ECG foundation models (ECGFounder, xECG, ECG-FM, DeepECG-SSL) in thirteen cohorts on four continents (5.4 million analysed ECGs, 31 endpoi

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