DynaGraph: interpretable dynamic graph learning for temporal electronic health records

Abstract Electronic health records (EHRs) capture evolving physiological processes, yet most machine learning models impose static or sequential assumptions that flatten their temporal and relational complexity. We introduce DynaGraph, a dynamic and interpretable graph learning framework that constructs evolving spatio-temporal graphs from multivariate clinical time-series. Unlike previous methods, DynaGraph learns the structure of relationships between different clinical variables over time without predefined graphs, integrates sequential embeddings with contrastive graph augmentation, and incorporates a pseudo-attention mechanism to reveal temporally resolved risk factors. Trained end-to-end with a novel multi-loss objective that combines focal, structural, and contrastive components, DynaGraph addresses two pervasive challenges in real-world clinical modelling: class imbalance and temporal instability. We evaluated DynaGraph on four large-scale EHR datasets totalling 40,856 patients: MIMIC-III (17,279 ICU admissions), eICU (1433 cardiac ICU patients), HiRID-ICU (33,000 patients), and EHRSHOT (2378 primary care patients). DynaGraph consistently outperforms 14 state-of-the-art baselines, achieving 6-8% relative improvements in area under the precision-recall curve (AUPRC) and significant gains in sensitivity (12-22% over leading methods). Beyond predictive performance, DynaGraph offers time-specific interpretability aligned with clinical reasoning, providing gradient-based feature importance scores at 3-hour intervals that identify which physiological relationships drive predictions. This framework explicitly models temporal attribution of risk factors across patient trajectories in a millisecond inference time.