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Practice trajectory
-26%
JD
Dr John Dolittle
Ashford Vale Medical Group
Patients/Thomas Brennan · SH-10331
← Practice Horizon

Thomas Brennan

78M · SH-10331OFF
Multimorbid (frailty) · Retired (carpenter)
Next consult
Fri 17 Apr, 11:15
Gray zone· p 0.61Trending worse
Trajectory headline
Frailty axis is the dominant trajectory driver. Intervention priority: deprescribing review and falls risk — not treatment intensification.
Model priority
Gray zone · pattern emerging
Biggest single change you could makeAdd GLP-1 → −24% (HbA1c)
Patient Context Card · AIME

Brief

Trajectory-grounded orientation for today's appointment.

Frailty is the dominant trajectory axis — not diabetes, not blood pressure. Treatment targets should loosen, not tighten.

Trajectory narrative

Thomas has T2DM, HTN, and early CKD, but Horizon-1's attribution identifies frailty as the primary driver of forward trajectory. Intensifying glycaemic or blood pressure control here would likely add burden without materially improving the 10-year envelope. The appropriate response is deprescribing review and falls risk assessment.

Active concerns
  • Two falls in last 6 months (neither injurious)
  • Polypharmacy — 9 regular medications
  • Clinical Frailty Scale 5 (mildly frail)
  • HbA1c 7.2% — acceptable at this frailty level
Suggested consultation focus
  • Structured medication review — deprescribe where appropriate
  • Falls-risk assessment (home-based if preferred)
  • Loosen HbA1c target to 58 mmol/mol (7.5%)
  • Discuss goals of care
Supporting record context
Current medications
Metformin · Gliclazide · Ramipril · Amlodipine · Bisoprolol · Atorvastatin · Alfuzosin · Paracetamol · Omeprazole
Allergies
Codeine (constipation)
Social
Lives with wife; mobility with stick indoors
For demonstration purposes. Not a diagnostic tool.
Horizon-1 · Syndrome activation

Latent clinical states

Output of the dynamic hypergraph. Direction = trajectory on that axis.

Frailty
0.70
Metabolic (late-onset)
0.48
Cardiorenal (mild)
0.44
For demonstration purposes. Not a diagnostic tool.