Heart failure management to avoid rehospitalization

• US 10,182,767 B2
• Filed: 03/02/2016
• Issued: 01/22/2019
• Est. Priority Date: 03/14/2013
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Thakur, Pramodsingh Hirasingh, An, Qi, Maskara, Barun, Thompson, Julie A.
• Primary Examiner(s): Patton, Amanda K
• Application Number:
  US15/058,613
• Publication Number:
  US 20160174904A1
• Time in Patent Office: 1,056 Days
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/091 Measuring volume of inspired or expired gases, e.g. to determine lung capacity
• CPC Class Codes: A61B 5/4848 Monitoring or testing the effects of treatment, e.g. of medication
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61B 5/746 Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

Systems and methods are described for subject rehospitalization management. In an example, multiple physiologic signals can be obtained from a subject using multiple sensors. In response to a hospitalization event, pre-hospitalization characteristics of the multiple physiologic signals can be identified. Post-hospitalization characteristics of the multiple physiologic signals can be identified, including characteristics that differ from their corresponding pre-hospitalization characteristics. Later subsequent physiologic signals can be further monitored after the hospitalization event, such as using the same multiple sensors, and subsequent physiologic signal characteristics can be identified. In an example, a heart failure diagnostic indication can be determined using information about the pre-hospitalization characteristics, the post-hospitalization characteristics, and the subsequent characteristics. Information about relative changes in signal characteristics from multiple sensors can be used to identify particular subject physiologic signals to monitor during subsequent periods.

Claims

1. A system comprising:

a physiologic sensor configured to sense a physiologic signal from a subject; and

a heart failure analysis module, coupled to the physiologic sensor, the heart failure analysis module including a processor circuit configured to;

identify a first physiologic signal characteristic corresponding to the physiologic signal and preceding a hospitalization event;

receive an indication of a hospital discharge event;

identify a second physiologic signal characteristic corresponding to the physiologic signal and following the hospital discharge event;

determine whether the second physiologic signal characteristic is substantially unchanged from the first physiologic signal characteristic; and

provide a rehospitalization indication when the second physiologic signal characteristic is determined to be substantially unchanged from the first physiologic signal characteristic.

2. The system of claim 1, wherein the processor circuit is configured to provide the rehospitalization indication when, after a specified duration following the hospital discharge event, the second physiologic signal characteristic is determined to be substantially unchanged from the first physiologic signal characteristic.

3. The system of claim 1, wherein the processor circuit is configured to provide the rehospitalization indication when, after a specified duration following the hospital discharge event, the second physiologic signal characteristic does not approach a known baseline signal characteristic for the physiologic signal.

4. The system of claim 1, further comprising an electrical energy delivery circuit configured to generate a electrostimulation therapy for the subject, wherein the processor circuit is configured to adjust the electrostimulation therapy based on the second physiologic signal characteristic being substantially unchanged from the first physiologic signal characteristic.

5. The system of claim 1, wherein the processor circuit is configured to provide the rehospitalization indication when, after a specified duration following the hospital discharge event, the second physiologic signal characteristic trends away from a known baseline signal characteristic for the physiologic signal.

6. The system of claim 1, wherein the physiologic sensor includes a heart sound sensor, and wherein the physiologic signal includes a heart sound signal sensed using the heart sound sensor.

7. The system of claim 1, wherein the physiologic sensor includes a respiration sensor, and wherein the physiologic signal includes a respiration signal sensed using the respiration sensor.

8. The system of claim 1, wherein the physiologic sensor includes a tidal volume sensor, and wherein the physiologic signal includes a tidal volume signal sensed using the tidal volume sensor.

9. The system of claim 1, further comprising at least a second physiologic sensor configured to sense a different physiologic signal from the subject;

wherein the heart failure analysis module is coupled to the second physiologic sensor; and

wherein the processor circuit is configured to withhold the rehospitalization indication when the different physiologic signal substantially corresponds with a known baseline signal level.

10. The system of claim 1, further comprising at least a second physiologic sensor configured to sense a different physiologic signal from the subject;

wherein the processor circuit is configured to receive the indication of the hospital discharge event when the different physiologic signal substantially corresponds to a pre-established baseline signal range for the different physiologic signal.

11. The system of claim 1, comprising an implantable electrostimulation device coupled to the subject, wherein the processor circuit is configured to use the physiologic signal to determine a heart failure parameter and a therapy parameter for a therapy provided to the subject by the implantable device based on the heart failure parameter, the therapy parameter including one of an AV delay, VV delay, an upper rate limit, a lower rate limit, a magnitude of an electrostimulation pulse, a duration of an electrostimulation pulse, a shape of an electrostimulation pulse, or a location for the electrostimulation pulse to be delivered to the subject.

12. The system of claim 1, further comprising an implantable medical device;

and

a memory circuit, coupled to the implantable medical device;

wherein the physiologic sensor is coupled to the memory circuit, and the memory circuit is configured to store information about the physiologic signal from the subject sensed using the physiologic sensor; and

wherein the processor circuit is configured to provide the rehospitalization indication using the information stored in the memory circuit, including using information about a pre-hospitalization physiologic signal characteristic.

13. A system comprising:

multiple physiologic sensors configured to sense respective physiologic signals from a subject; and

a heart failure analysis module, coupled to the physiologic sensor, the heart failure analysis module including a processor circuit configured to;

identify a first physiologic signal characteristic corresponding to a first one of the physiologic signals and preceding a hospitalization event, the first physiologic signal characteristic being outside of a first pre-established baseline range;

identify a second physiologic signal characteristic corresponding to a second one of the physiological signals and preceding a hospitalization event, the second physiologic signal characteristic being outside of a second pre-established baseline range;

identify a third physiologic signal characteristic corresponding to the first one of the physiologic signals and indicating a response to a subject therapy following the hospitalization, the third physiologic signal characteristic being within the first pre-established baseline range;

provide a hospital discharge indication based on the indicated response to the subject therapy;

identify a fourth physiologic signal characteristic corresponding to the a second one of the physiologic signals and following the hospital discharge event;

determine whether the fourth physiologic signal characteristic is substantially unchanged from the second physiologic signal characteristic; and

provide a rehospitalization indication when the fourth physiologic signal characteristic is determined to be substantially unchanged from the second physiologic signal characteristic.

14. A method comprising:

monitoring a physiologic signal obtained using a physiologic sensor;

identifying a subject-specific first physiologic signal characteristic corresponding to the physiologic signal and preceding a hospitalization event;

receiving an indication of a hospital discharge event;

identifying a second physiologic signal characteristic corresponding to the physiologic signal and following the hospital discharge event;

determining whether the second physiologic signal characteristic is substantially unchanged from the first physiologic signal characteristic; and

providing a rehospitalization indication when the second physiologic signal characteristic is determined to be substantially unchanged from the first physiologic signal characteristic.

15. The method of claim 14, further comprising monitoring at least one other physiologic signal over an interval between the hospitalization event and the hospital discharge event, wherein the receiving the indication of the hospital discharge event includes in response to identifying a characteristic of the other physiologic signal that trends toward a corresponding baseline characteristic value.

16. The method of claim 14, wherein the providing the rehospitalization indication includes after a specified duration following the hospital discharge event when the second physiologic signal characteristic is determined to be substantially unchanged from the first physiologic signal characteristic.

17. The method of claim 14, wherein the providing the rehospitalization indication further includes after a specified duration following the hospital discharge event when the second physiologic signal characteristic does not approach the first physiologic signal characteristic.

18. The method of claim 14, further comprising identifying a subject-specific baseline characteristic for the physiologic signal;

determining whether the second physiologic signal characteristic is substantially unchanged from the subject-specific baseline characteristic following the hospital discharge event; and

providing the rehospitalization indication when the second physiologic signal characteristic is determined to be substantially unchanged from the subject-specific baseline characteristic following the hospital discharge event.

19. The method of claim 14, further comprising generating a subject therapy, using an implantable medical device, in response to the rehospitalization indication.

20. The method of claim 14, further comprising, in response to the hospital discharge event, identifying a second physiologic signal having a characteristic that changed in response to a therapy administered following the hospitalization event;

identifying information about a trend of the characteristic of the second physiologic signal following the hospital discharge event; and

providing the rehospitalization indication based in part on the information about the trend of the characteristic of the second physiologic signal following the hospital discharge event.