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Robert Johnson

Robert Johnson

Digital Twin Active
MRN: 847291 67 years old Male San Francisco, CA
Atrial Fibrillation Type 2 Diabetes Hypertension Blue Shield PPO

Robert's Digital Twin

AI-powered health model • Last synced 2 min ago

Live Monitoring
Digital Twin initialized with complete health history, 847 days of wearable data, and 23 patient conversations.
Robert's Digital Twin Today, 8:45 AM

Morning Health Summary:

Based on overnight wearable data, I've detected several patterns worth noting:

  • Irregular heart rhythm detected between 3:00-4:30 AM — consistent with atrial fibrillation episodes. This is the 3rd occurrence this week.
  • Average heart rate during sleep: 72 bpm (elevated from baseline of 64 bpm)
  • Sleep quality score: 62/100 — fragmented sleep with 4 awakenings
  • Blood glucose (CGM): Stable overnight, fasting level 128 mg/dL

Recommendation: Consider reviewing current rate control medication. The increasing AF frequency may warrant rhythm control strategy discussion.

Apple Watch Dexcom G7 Sleep Data
Dr. Sarah Chen Today, 9:12 AM

Show me the AF episode details and compare to previous occurrences. Also, what's his current medication adherence looking like?

Dr. Chen
Robert's Digital Twin Today, 9:12 AM

AF Episode Analysis:

Last Night's Episode (3:02 AM - 4:28 AM)

Duration 86 minutes
Avg HR 112 bpm
Peak HR 138 bpm
HRV 23 ms
Irregular Rhythm Detected

Comparison to Previous Episodes (Last 30 Days):

Feb 3
52 min
Feb 1
34 min
Jan 28
22 min
Jan 20
18 min

Trend: Episode duration and frequency increasing. Episodes went from monthly to 3x/week over 45 days.

Medication Adherence (Last 30 Days):

Metoprolol 50mg
93%
Eliquis 5mg
100%
Metformin 1000mg
78%
Lisinopril 20mg
96%

Metformin adherence dropped — patient mentioned GI discomfort in chat 5 days ago.

Dr. Sarah Chen Today, 9:18 AM

What did Robert say about the GI symptoms? And has he mentioned anything about the AF episodes - is he symptomatic?

Dr. Chen
Robert's Digital Twin Today, 9:18 AM

Relevant Patient Conversations:

Conversation with Robert — Jan 31, 2:34 PM
Robert: "The metformin is really bothering my stomach lately. I've been skipping it some days when I know I'll be out. Is there something else I can take?"
AI Assistant: "I understand the GI discomfort is frustrating. Some patients find taking it with food helps. There are also extended-release formulations that may be gentler. I'll flag this for Dr. Chen to discuss alternatives with you."
Conversation with Robert — Feb 4, 7:15 AM
Robert: "Woke up feeling my heart racing again last night. It's happened a few times recently. Should I be worried?"
AI Assistant: "I can see from your Apple Watch that you had an irregular rhythm episode last night. Given your AF history, this warrants attention. Are you experiencing any other symptoms like dizziness, shortness of breath, or chest discomfort?"
Robert: "A little short of breath when it happens. And sometimes lightheaded when I get up. But it goes away."
AI Assistant: "Thank you for sharing that. The combination of increasing AF episodes with symptoms like shortness of breath and lightheadedness is important for Dr. Chen to know. I'm escalating this for physician review today."

Summary: Patient IS symptomatic during AF episodes (palpitations, SOB, lightheadedness). Combined with increasing episode frequency and the Metformin adherence issue, I recommend scheduling a comprehensive medication review visit.

Robert Johnson

Chat with Robert Johnson

Last active 2 hours ago

Previous Conversations
January 28, 2026

Topic: AF Episode Follow-up

"I wanted to check in after the episode last week..."

January 15, 2026

Topic: Lab Results Discussion

"Your A1C came back at 7.8%, which is slightly elevated..."

December 20, 2025

Topic: Medication Adjustment

"Based on your recent readings, I'd like to adjust..."

Current Conversation
Robert
Robert Johnson Today, 7:23 AM

Good morning Dr. Chen. I wanted to let you know about last night - my watch alerted me again about irregular heartbeat. It happened around 3 AM and I felt pretty uncomfortable. Racing heart, a bit short of breath.

Robert

This is the third time this week. I'm getting a bit worried. Is this something we should look at more seriously?

7:24 AM
Robert
Apple Watch Screenshot

Here's the screenshot from my watch showing the irregular rhythm alert.

7:25 AM
Digital Twin Draft Response Suggested

Good morning Robert. Thank you for reaching out and sharing this with me. I've reviewed your wearable data and I can see the AF episode from last night - it lasted about 86 minutes with your heart rate averaging 112 bpm.

Given that this is your third episode this week and you're experiencing symptoms (shortness of breath, palpitations), I think we should discuss adjusting your treatment approach. Your current rate control with Metoprolol may not be sufficient anymore.

I'd like to schedule a telehealth visit this week to discuss the following options:

  • Increasing your Metoprolol dose
  • Adding or switching to a rhythm control strategy
  • Possible referral to electrophysiology for ablation consultation

In the meantime, please continue taking your Eliquis as prescribed - this is very important for stroke prevention. Are you available Thursday or Friday for a video visit?

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Robert's Care Plan

Last updated Feb 4, 2026 by Dr. Sarah Chen

Active

Care Goals

AF Management
40%
  • Evaluate rhythm control vs. rate control strategy
  • EP consult for ablation candidacy
  • Holter monitoring completed
  • Reduce AF episodes to <1/week
Diabetes Management
55%
  • A1C target <7.0% (currently 7.8%)
  • Address Metformin GI intolerance — consider XR switch
  • CGM monitoring established (Dexcom G7)
  • Quarterly A1C labs ordered
Hypertension Control
70%
  • BP target <130/80 (current avg 138/88)
  • Lisinopril 20mg daily — adherence 96%
  • Home BP monitoring with Withings BPM
  • Consider dose increase if not at target in 30 days
Lifestyle & Prevention
35%
  • Increase daily steps to 6,000 (current avg 3,200)
  • Improve sleep quality — target 7h+ nightly
  • Weight reduction goal: 190 lbs (current 198 lbs)
  • Statin therapy at target — LDL 98

Current Interventions

Metoprolol 50mg BID
Rate control for AF — adherence 93%
Active
Eliquis 5mg BID
Anticoagulation for AF — adherence 100%
Active
Metformin 1000mg BID
Diabetes — adherence 78% GI intolerance reported
Review
Continuous wearable monitoring
Apple Watch (ECG/HR) + Dexcom G7 (glucose) + Withings (BP)
Active
Monthly telehealth check-ins
Next: Feb 12, 2026 with Dr. Chen
Active

Plan Timeline

Feb 4, 2026 AI flagged increasing AF episode frequency — EP referral recommended
Jan 31, 2026 Patient reported Metformin GI discomfort via chat — flagged for review
Jan 15, 2026 Follow-up visit with Dr. Chen — AF monitoring plan updated, labs ordered
Dec 8, 2025 Holter results reviewed by Dr. Park — paroxysmal AF confirmed, rate control continued
Nov 20, 2025 Endocrinology visit — A1C 7.8%, Metformin continued, CGM initiated
Oct 1, 2025 Care plan created — multi-condition management for AF, DM2, HTN

Medical Records

47 documents on file

Pinned Documents

Comprehensive Metabolic Panel + A1C
UCSF Lab Dr. Chen
Jan 15, 2026
Holter Monitor Report (48h)
Stanford Health Dr. Park
Dec 5, 2025

Recent Documents

Follow-up Visit Note
Dr. Sarah Chen Clinical Note
Jan 15, 2026
Lipid Panel
UCSF Lab Lab Result
Jan 15, 2026
Cardiology Referral — Electrophysiology
Dr. Chen → Dr. Park Referral
Dec 1, 2025
AF Monitoring Visit Note
Dr. James Park Clinical Note
Dec 8, 2025
Echocardiogram Report
Stanford Health Imaging
Nov 28, 2025
Endocrinology Visit Note — A1C Review
Dr. Maria Santos Clinical Note
Nov 20, 2025
Prescription — Dexcom G7 CGM
Dr. Santos Prescription
Nov 20, 2025