HEAL-AI: Enabling proactive and personalized smart healthcare through hierarchical edge autonomous learning.

Objective: This study aims to develop a proactive, personalized, and privacy-preserving smart healthcare framework that enables real-time clinical decision support across distributed healthcare environments while ensuring interpretability, low latency, and regulatory compliance. Methods: This study proposes HEAL-AI (Healthcare Empowerment via Adaptive Learning with Artificial Intelligence), a federated neuro-symbolic framework that integrates federated learning, hierarchical contextual attention, symbolic medical reasoning, and edge intelligence optimization. The system supports collaborative model training across hospitals, clinics, and wearable devices without sharing raw patient data. Privacy is enforced using secure aggregation and differential privacy mechanisms, while edge intelligence techniques such as model compression and adaptive offloading enable real-time inference on resource-constrained devices. HEAL-AI was evaluated on multiple benchmark datasets, including MIMIC-III, PhysioNet/Computing in Cardiology Challenge 2019, eICU, MIMIC-IV, and a custom HEAL-Wearable dataset. Performance was assessed using diagnostic accuracy, early-detection lead time, inference latency, energy consumption, explainability scores from clinical experts, and privacy leakage under standard attack models. Results: Across all datasets, HEAL-AI consistently outperformed state-of-the-art baselines. The framework achieved up to 17.3% improvement in diagnostic accuracy, enabled early sepsis detection by 5.9 h, and reduced inference latency and energy consumption by 32.6% on edge devices. Explainability evaluations showed a 43.5% improvement over the strongest neuro-symbolic baseline, with high symbolic rule coverage (94.3%) and strong clinical agreement. Under differential privacy with Conclusions: HEAL-AI demonstrates that federated neuro-symbolic learning combined with edge intelligence can deliver accurate, explainable, and privacy-preserving healthcare artificial intelligence (AI). The framework is well suited for real-world deployment in critical care, remote monitoring, and personalized clinical decision support. Index Terms: Federated learning, neuro-symbolic AI, smart healthcare, edge intelligence, personalized medicine, explainable AI, differential privacy, IoT healthcare.