James O'Brien

81 M · DOB 1944-06-30 · MRN DEMO-1004

ALLERGY · Iodinated contrast (anaphylaxis)ALLERGY · Aspirin (GI bleed)Complex history4 admissions/12moFall risk

Primary providerDr. Amanda Reyes, MD

NurseBrandon S., RN

Last visit2026-04-05

Active problems

·Ischemic cardiomyopathy (EF 25%)I25.5
·AICD placementZ95.810
·Atrial fibrillationI48.91
·Chronic kidney disease, Stage 4N18.4
·COPDJ44.9
·History of GI bleed (2021)K92.2· History
·OsteoarthritisM19.90

Recent labs

Creatinine

2.4

2026-04-05 · HIGH

eGFR

2026-04-05 · LOW

Potassium

5.2

2026-04-05 · HIGH

BNP

1420

2026-04-05 · HIGH

Hemoglobin

10.4

2026-04-05 · LOW

Risk scores

Hf Readmission30Day

Mortality Risk90Day

Adherence Estimate

Guideline Concordance

Guideline gaps

Sacubitril/valsartan below target dose
On 24/26 BID. Target is 97/103 BID for max benefit, but renal function limits titration.
priority · low

AI Insights

Last analysis: 14 seconds ago

Daughter's message matches prior decompensation prodrome 3 of 3 times

Day-25 post-discharge fatigue + decreased PO intake without overt edema preceded the December 2025, August 2025, and May 2025 admissions by a median of 9 days. Proactive outreach now correlates with the prevented-event pattern.

Prevented-event pattern · personal-history match

Confidence: High

›Why did Kairos say this?

Data sources consulted

·MyChart message 2026-04-22 (daughter, proxy)
·Admissions 2025-05, 2025-08, 2025-12 prodrome notes
·Discharge 2026-03-28 (day 25 today)

Rules applied

·Personal-history prodrome match
·Post-discharge 30-day window monitor

Output validated by

·Prevented-event pattern post-processor

Confidence reasoning

Three-for-three personal-history match within the same post-discharge window. Strong prior; deterministic match.

Renal ceiling on sacubitril/valsartan titration

Current 24/26 BID is the functional ceiling given Cr 2.4 / eGFR 26 / K+ 5.2. Prior titration attempt bumped creatinine. Document and stop attempting upward titration.

Confidence: High

›Why did Kairos say this?

Data sources consulted

·Labs 2026-04-05 (Cr, eGFR, K+)
·Intervention 2025-08-20 titration attempt

Rules applied

·ARNI dose-ceiling by renal function

Output validated by

·Renal-dosing post-processor

Confidence reasoning

Deterministic dose-cap rule satisfied.

Goals-of-care conversation pending. Palliative referral 2 weeks out.

Fourth HF admission in 12 months and functional decline (now using walker). Referral placed 2026-04-05; first appointment still pending.

Confidence: High

›Why did Kairos say this?

Data sources consulted

·Intervention 2026-04-05 referral
·Admissions log (4 in 12 mo)

Rules applied

·Palliative-referral follow-through tracker

Output validated by

·Referral-status post-processor

Confidence reasoning

Status field is "pending" with no scheduled date.