POTS
Your patient's heart rate jumped 40 beats standing up this morning. Their chart says 'stable.'
POTS symptoms shift hour to hour — driven by hydration, sleep, heat, menstrual phase, and medication timing — yet no validated POTS-specific outcome measure exists, and clinic assessments capture none of this variability. The RECOVER-AUTONOMIC trial proved that lowering heart rate doesn't mean patients feel better. Forma captures the multi-domain daily signal that connects symptoms to their triggers.
Forecast
Based on prior Topics logging
Topics
How it works
15 seconds of speech. 25 data points.
Forma turns each patient into a continuous data stream. By voice or text, patients log orthostatic episodes with heart rate context, brain fog severity, fatigue levels, hydration and sodium intake, exercise tolerance, GI symptoms, and thermoregulatory events in 20 seconds. No forms, no recall bias — and voice-first matters because many patients are logging from bed on their worst days. The result is a structured, longitudinal dataset across all six POTS clinical domains — daily hydration paired with next-day symptom severity, exercise type correlated with crash onset, and menstrual cycle phase mapped against orthostatic tolerance.
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Forecast
Based on prior Topics logging
Topics
Structured, coded, longitudinal
- Timing
- Onset time:10:00 AMTrigger duration:30 min
- Location
- Ptosis location:Bilateral eyelids
- Severity
- Symptom:DiplopiaPtosis:PresentBulbar symptom:Chewing difficulty
- Actions
- Trigger activity:Sustained readingMedication:PyridostigmineDose:60 mg
- Environmental
- Barometric pressure:30.12 inHg (steady)
- Outcome
- Response time:Within 1 hour
From data to insights
What the data reveals
Daily voice logs compound into actionable insights — for patients managing their condition and for researchers running studies.
For Patients
Why are some days so much worse?
Your worst days follow a pattern: low hydration (<2L) the day before predicts next-day brain fog in 8 of 10 cases. Your menstrual days 1–3 consistently spike orthostatic symptoms. Hot days above 85°F triple your near-syncope episodes. Today's fog score of 8 followed yesterday's 1.5L intake.
Fog vs. hydration
Is the midodrine helping?
Before the dose increase, your standing HR averaged 118 bpm. This week it's averaging 97. Near-syncope episodes dropped from 5/week to 1. Your best day yet — HR only hit 95 standing — was day 9, three days after the increase. Morning pre-dosing with salt water is adding another 8 bpm of benefit.
Standing HR trend
Which exercises are safe for me?
Recumbent exercise (swimming, recumbent bike) has zero crash days in your logs. Upright walking triggered post-exertional crashes in 3 of 4 attempts — average crash onset: 3 hours post-activity. Your Levine protocol is working: you've gone from 10-minute recumbent sessions to 30 minutes in 6 weeks.
Exercise tolerance
Summarize this month for my cardiologist.
Near-syncope: 8 episodes (down from 14 last month). One ER visit day 5 — syncope during menstrual flare. Standing HR average: 102 (was 118). Brain fog: 4.2/10 average (was 6.1). Hydration target met 18 of 30 days. Post-exertional crashes: 3, all from upright activity. First dinner outing without crash on day 21.
For Researchers
What predicts symptom severity in POTS?
Across 56 POTS patients, prior-day fluid intake explains 34% of next-day symptom variance (p<0.001). Menstrual phase adds 12% for female patients. Sleep quality adds 9%. Combined, these three factors predict 55% of daily severity — vs. 0% captured at quarterly visits. A 3-variable daily model outperforms any single tilt-table metric.
Variance explained
Trend
Does heart rate reduction equal symptom improvement?
Heart rate reduction correlates weakly with symptom improvement (r=0.29). Brain fog severity is independent of HR delta (r=0.08). Fatigue correlates better with sleep quality (r=0.52) than orthostatic metrics. This confirms RECOVER-AUTONOMIC findings: HR is a biomarker, not a patient-relevant outcome. Multi-domain daily PROs are essential.
HR vs. symptoms
Trend
What is the real post-exertional crash rate?
Upright exercise triggers crashes in 41% of sessions (median onset: 3.2 hours post-activity). Recumbent exercise: 4% crash rate. Graduated protocol adherence is 72% for recumbent vs. 34% for upright — patients self-select away from activities that crash them. Daily logging captures the crash-to-exercise relationship 8x better than weekly recall.
Crash rate by type
Trend
Can daily data serve as a POTS-specific PRO?
A 6-domain daily composite (orthostatic, cognitive, fatigue, GI, thermoregulatory, sleep) shows test-retest reliability of 0.84 and responsiveness (SRM 0.91) to medication changes. It detects clinically meaningful change 18 days earlier than monthly Composite Autonomic Symptom Score. This could fill the missing validated POTS PRO gap.
PRO sensitivity
Trend
Baseline check-in. Stood up and HR went to about 120. Near-syncope in shower. Hydration: 2L water, 4 salt tablets. Brain fog moderate.
Only managed 1 liter of water, fell behind on fluids. Urine dark yellow. Brain fog terrible — forgot a meeting, couldn't follow conversation.
Started period. POTS symptoms immediately worse — way more dizzy and fatigued. Nauseous, couldn't eat breakfast.
Day 2 of period. Heavy flow. Worst day of the month. Completely wiped — cancelled dinner, spent afternoon in bed.
Went to the ER after fainting and hitting her head. IV saline — felt amazing for about a day. Sent home.
Saw cardiologist. Increasing midodrine. Did 20 minutes on recumbent bike — easy effort, no crash. Good hydration day: 3L, 2 LMNT, broth.
Good morning — stood up and only went to about 95 HR. Took midodrine first thing plus salt water before getting up. Made it through a whole workday.
Tried a 15-minute walk. Had to stop from dizziness. Crashed 3 hours later — in bed rest of the day.
Slept really well with wedge pillow — 8 hours, no nocturnal symptoms. Clear-headed today, brain fog maybe a 2. Labs: norepinephrine elevated, iron low.
Had monthly IVIg infusion. 4-hour session, mild headache after. No nausea today — ate three normal meals for the first time this week.
Actually had a really good day. Went out for dinner AND didn't crash. First time in weeks. Feeling hopeful.
Key insight
Over three weeks, Emma's daily logs reveal the multi-domain patterns that a clinic visit cannot capture: a perimenstrual flare from days 3-5 that culminated in an ER visit, the precise correlation between her 1-liter dehydration day and next-day brain fog spike, and an upright walking crash on day 11 that contrasts with successful recumbent exercise on day 7. Post-midodrine increase, her standing heart rate dropped from 120+ to 95 by day 9, and by day 21 she completed a dinner outing without a crash — a trajectory visible in the daily data two weeks before her next scheduled appointment.