{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:07:24Z","timestamp":1780337244067,"version":"3.54.1"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosdigitalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Digit Health"],"abstract":"<jats:p>Cardiovascular diseases cause nearly one-third of global deaths, yet standalone National Cardiovascular Disease Control Plans remain uncommon and inconsistently structured. We assessed the comprehensiveness of recent national plans using a validated health-systems framework and a multi-agent artificial intelligence model. We identified the most recent official plan for 45 countries from World Health Organisation and World Heart Federation repositories and government sources. We adapted a health-systems planning framework for cardiovascular disease and validated it through a two-stage expert consensus process involving 42 specialists from 28 countries, resulting in 11 elements and 69 sub-elements with standardised definitions and scoring criteria. Plans were analysed using a three-stage artificial intelligence pipeline that ingested documents, applied framework-based scoring, and performed automated validation checks. Sub-elements were scored on a 0\u20135 scale and summarised by element, World Health Organisation region, and World Bank income group. Overall comprehensiveness was low (median 1.20\/5). Plans most consistently addressed strategic direction (median 2.80) and governance arrangements (2.14). Contextual assessment was deficient \u2014 threats (0.12) and opportunities (0.29) \u2014 as were performance specification elements, including objectives (0.50) and health system outcomes (0.67). The Western Pacific region scored highest (median 1.71) and Africa lowest (0.90), though scores remained below moderate levels across all regions. Income group pairwise comparisons were non-significant across all groups; given the small LIC sample (n\u2009=\u20092), no inferential conclusions about income group differences are drawn. Validation against blinded human review across six countries showed 43.7%exact agreement and 68.0%agreement within one point; ordinal agreement statistics were uniformly weak and non-significant, indicating the approach is validated for structural benchmarking rather than fine-grained qualitative judgement. Most national cardiovascular disease plans articulate vision without sufficient operational detail, particularly for contextual analysis, measurement, and integrated financing. Standardised planning templates and artificial intelligence\u2013supported benchmarking, complemented by expert review, could strengthen national planning quality and enable scalable global comparisons.<\/jats:p>","DOI":"10.1371\/journal.pdig.0001447","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:26:26Z","timestamp":1780334786000},"page":"e0001447","update-policy":"https:\/\/doi.org\/10.1371\/journal.pdig.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A global analysis of national cardiovascular disease control plans using a multi-agent artificial intelligence model"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0899-4068","authenticated-orcid":true,"given":"Hugh","family":"Pearson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7084-1559","authenticated-orcid":true,"given":"Caleb J.","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Che L.","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estella Rose","family":"LeBlanc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-5983","authenticated-orcid":true,"given":"Rifat","family":"Atun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"With the CVD Control Collaborative","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"pdig.0001447.ref001","unstructured":"World Health Organisation. The top 10 causes of death. Geneva: World Health Organisation; 2024. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death"},{"key":"pdig.0001447.ref002","first-page":"28","article-title":"Global Trends in Cardiovascular Mortality and Risk Factors: Insights from WHO and Global Burden of Disease Data","author":"I Hamza Khalifa","year":"2025","journal-title":"Libyan Open Univ J Med Sci Sustain"},{"key":"pdig.0001447.ref003","unstructured":"World Health Organisation. Cardiovascular diseases (CVDs). Geneva: World Health Organisation. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds"},{"issue":"3","key":"pdig.0001447.ref004","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1161\/HYPERTENSIONAHA.123.21354","article-title":"Social determinants of health and disparities in hypertension and cardiovascular diseases","volume":"81","author":"A Chaturvedi","year":"2024","journal-title":"Hypertension"},{"key":"pdig.0001447.ref005","doi-asserted-by":"crossref","DOI":"10.5888\/pcd19.220347","article-title":"Global responses to prevent, manage, and control cardiovascular diseases","volume":"19","author":"F Coronado","year":"2022","journal-title":"Prev Chronic Dis"},{"key":"pdig.0001447.ref006","unstructured":"World Heart Federation. CVD roadmaps. Geneva: World Heart Federation; https:\/\/world-heart-federation.org\/cvd-roadmaps\/"},{"key":"pdig.0001447.ref007","unstructured":"World Heart Federation. WHF urges countries to develop cardiovascular action plans, launches global petition. Geneva: World Heart Federation; https:\/\/world-heart-federation.org\/news\/whf-urges-countries-to-develop-cardiovascular-action-plans-launches-global-petition\/"},{"key":"pdig.0001447.ref008","volume-title":"Cancer prevention and control in the context of an integrated approach: World Health Assembly resolution WHA70.12","author":"World Health Organisation","year":"2017"},{"key":"pdig.0001447.ref009","unstructured":"The Global Goals. Goal 3: good health and well-being. https:\/\/globalgoals.org\/goals\/3-good-health-and-well-being\/"},{"key":"pdig.0001447.ref010","volume-title":"HEARTS technical package for cardiovascular disease management in primary health care","author":"World Health Organisation","year":"2016"},{"key":"pdig.0001447.ref011","unstructured":"Meta AI. The Llama 4 herd: the beginning of a new era of natively multimodal AI innovation. 2025. https:\/\/ai.meta.com\/blog\/llama-4-multimodal-intelligence\/"},{"key":"pdig.0001447.ref012","first-page":"35327","article-title":"LegalBench: a collaboratively built benchmark for measuring legal reasoning in large language models","volume":"36","author":"N Guha","year":"2023","journal-title":"Adv Neural Inf Process Syst"},{"key":"pdig.0001447.ref013","doi-asserted-by":"crossref","first-page":"3005","DOI":"10.1007\/s10462-022-10246-w","article-title":"Human-in-the-loop machine learning: a state of the art","volume":"56","author":"E Mosqueira-Rey","year":"2023","journal-title":"Artif Intell Rev"},{"issue":"4","key":"pdig.0001447.ref014","first-page":"105","article-title":"Power to the People: The Role of Humans in Interactive Machine Learning","volume":"35","author":"S Amershi","year":"2014","journal-title":"AI Mag"},{"key":"pdig.0001447.ref015","unstructured":"World Health Organisation. Noncommunicable disease (NCD) document repository. Geneva: World Health Organisation. https:\/\/extranet.who.int\/ncdccs\/documents\/"},{"key":"pdig.0001447.ref016","volume-title":"Analysis of national cancer control programmes in Europe","author":"R Atun","year":"2008"},{"issue":"4","key":"pdig.0001447.ref017","doi-asserted-by":"crossref","first-page":"116","DOI":"10.5662\/wjm.v11.i4.116","article-title":"Delphi methodology in healthcare research: How to decide its appropriateness","volume":"11","author":"P Nasa","year":"2021","journal-title":"World J Methodol"},{"key":"pdig.0001447.ref018","unstructured":"Bai S, Yang A, Cheng J, et al. Qwen2.5-VL technical report. arXiv. 2025. https:\/\/arxiv.org\/abs\/2502.13923"},{"key":"pdig.0001447.ref019","unstructured":"International Cancer Control Partnership (ICCP). National plans. https:\/\/iccp-portal.org\/map"},{"issue":"12","key":"pdig.0001447.ref020","article-title":"National cancer control plans","volume":"19","author":"Society of Academic Primary Care Cancer Special Interest Group","year":"2018","journal-title":"Lancet Oncol"},{"issue":"11","key":"pdig.0001447.ref021","doi-asserted-by":"crossref","DOI":"10.1016\/S1470-2045(21)00410-1","article-title":"National cancer control plans across the Eastern Mediterranean region: challenges and opportunities to scale-up","volume":"22","author":"I Fadhil","year":"2021","journal-title":"Lancet Oncol"},{"issue":"4","key":"pdig.0001447.ref022","doi-asserted-by":"crossref","DOI":"10.1016\/S1470-2045(13)70100-1","article-title":"Developing cancer control plans in Africa: examples from five countries","volume":"14","author":"DC Stefan","year":"2013","journal-title":"Lancet Oncol"},{"issue":"1","key":"pdig.0001447.ref023","doi-asserted-by":"crossref","DOI":"10.1016\/S1470-2045(24)00405-4","article-title":"The changing global landscape of national cancer control plans","volume":"26","author":"Y Romero","year":"2025","journal-title":"Lancet Oncol"}],"container-title":["PLOS Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pdig.0001447","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:26:40Z","timestamp":1780334800000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pdig.0001447"}},"subtitle":[],"editor":[{"given":"Cleva","family":"Villanueva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":23,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pdig.0001447","relation":{},"ISSN":["2767-3170"],"issn-type":[{"value":"2767-3170","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}