Automated method for diagnosing and monitoring the outcomes of atrial fibrillation

• US 20020099303A1
• Filed: 08/13/2001
• Published: 07/25/2002
• Est. Priority Date: 11/16/1999
• Status: Active Grant

• Current Assignee: Gust H. Bardy
• Original Assignee: Gust H. Bardy
• Inventors: Bardy, Gust H.
• Granted Patent: US 6,704,595 B2
• Time in Patent Office: Days
• US Class Current: 600/515
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: Y10S 128/923 by comparison of patient data to other data

Abstract

An automated system and method for diagnosing and monitoring the outcomes of atrial fibrillation is described. A plurality of monitoring sets is retrieved from a database. Each of the monitoring sets include recorded measures relating to patient information recorded on a substantially continuous basis. A patient status change is determined in response to an atrial fibrillation diagnosis by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure. Both recorded measures relate to the same type of patient information. Each patient status change is tested against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared. The indicator threshold corresponds to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation.

Claims

1. An automated system for diagnosing and monitoring the outcomes of atrial fibrillation, comprising:

a database storing a plurality of monitoring sets which each comprise recorded measures relating to patient information recorded on a substantially continuous basis;

a comparison module determining a patient status change in response to an atrial fibrillation diagnosis by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

an analysis module testing each patient status change against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation.

2. An automated system according to claim 1, further comprising:

the analysis module managing the atrial fibrillation diagnosis through administration of at least one of ventricular rate response control and normal sinus rhythm restoration.

3. An automated system according to claim 1, further comprising:

a database module periodically receiving a monitoring set for an individual patient, each recorded measure in the monitoring set having been recorded by at least one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded and storing the received monitoring set in the database as part of a patient care record for the individual patient.

4. An automated system according to claim 3, further comprising:

a set of further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation;

the comparison module comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure; and

testing each patient status change against each such further indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

5. An automated system according to claim 1, further comprising:

the comparison determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure.

6. An automated system according to claim 1, further comprising:

a set of stickiness indicators for each type of patient information, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;

the comparison module comparing a time span occurring between each patient status change for each recorded measure to the stickiness indicator relating to the same type of patient information as the recorded measure being compared; and

the analysis module determining a revised program of patient diagnosis or treatment responsive to each patient status change occurring subsequent to a time span exceeding the stickiness indicator.

7. An automated system according to claim 1, further comprising:

a database module retrieving the plurality of monitoring sets from one of a patient care record for an individual patient, a peer group, and a overall patient population.

8. An automated system according to claim 1, further comprising:

the database further storing a reference baseline comprising recorded measures which each relate to patient information recorded during an initial time period and comprise either medical device measures or derived measures calculable therefrom; and

a database module obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

9. An automated system according to claim 1, wherein the indicator thresholds relate to at least one of a finding of reduced exercise capacity, respiratory distress and palpitations/symptoms.

10. An automated system according to claim 9, wherein the indicator thresholds relating to the finding of reduced exercise capacity are selected from the group comprising decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.

11. An automated system according to claim 9, wherein the indicator thresholds relating to the finding of respiratory distress are selected from the group comprising increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.

13. An automated method according to claim 12, further comprising:

managing the atrial fibrillation diagnosis through administration of at least one of ventricular rate response control and normal sinus rhythm restoration.

14. An automated method according to claim 12, further comprising:

periodically receiving a monitoring set for an individual patient, each recorded measure in the monitoring set having been recorded by at least one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded; and

storing the received monitoring set in the database as part of a patient care record for the individual patient.

15. An automated method according to claim 14, further comprising:

defining a set of further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation;

comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure; and

testing each patient status change against each such further indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

16. An automated method according to claim 12, further comprising:

determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure.

17. An automated method according to claim 12, further comprising:

defining a set of stickiness indicators for each type of patient information, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;

comparing a time span occurring between each patient status change for each recorded measure to the stickiness indicator relating to the same type of patient information as the recorded measure being compared; and

determining a revised program of patient diagnosis or treatment responsive to each patient status change occurring subsequent to a time span exceeding the stickiness indicator.

18. An automated method according to claim 12, further comprising:

retrieving the plurality of monitoring sets from one of a patient care record for an individual patient, a peer group, and a overall patient population.

19. An automated method according to claim 12, further comprising:

retrieving a reference baseline comprising recorded measures which each relate to patient information recorded during an initial time period and comprise either medical device measures or derived measures calculable therefrom; and

obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retreived reference baseline.

20. An automated method according to claim 12, wherein the indicator thresholds relate to at least one of a finding of reduced exercise capacity, respiratory distress and palpitations/symptoms.

21. An automated method according to claim 20, wherein the indicator thresholds relating to the finding of reduced exercise capacity are selected from the group comprising decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.

22. An automated method according to claim 20, wherein the indicator thresholds relating to the finding of respiratory distress are selected from the group comprising increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.

24. A storage medium according to claim 23, further comprising:

managing the atrial fibrillation diagnosis through administration of at least one of ventricular rate response control and normal sinus rhythm restoration.

25. A storage medium according to claim 23, further comprising:

periodically receiving a monitoring set for an individual patient, each recorded measure in the monitoring set having been recorded by at least one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded; and

storing the received monitoring set in the database as part of a patient care record for the individual patient.

26. A storage medium according to claim 25, further comprising:

defining a set of further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation;

comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure; and

testing each patient status change against each such further indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

27. A storage medium according to claim 23, further comprising:

determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure.

28. A storage medium according to claim 23, further comprising:

defining a set of stickiness indicators for each type of patient information, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;

comparing a time span occurring between each patient status change for each recorded measure to the stickiness indicator relating to the same type of patient information as the recorded measure being compared; and

determining a revised program of patient diagnosis or treatment responsive to each patient status change occurring subsequent to a time span exceeding the stickiness indicator.

29. A storage medium according to claim 23, further comprising:

retrieving the plurality of monitoring sets from one of a patient care record for an individual patient, a peer group, and a overall patient population.

30. A storage medium according to claim 23, further comprising:

retrieving a reference baseline comprising recorded measures which each relate to patient information recorded during an initial time period and comprise either medical device measures or derived measures calculable therefrom; and

obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

12. An automated method for diagnosing and monitoring the outcomes of atrial fibrillation, comprising:

retrieving a plurality of monitoring sets from a database which each comprise recorded measures relating to patient information recorded on a substantially continuous basis;

determining a patient status change in response to an atrial fibrillation diagnosis by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

testing each patient status change against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation.

23. A computer-readable storage medium containing code for an automated method for diagnosing and monitoring the outcomes of atrial fibrillation, comprising:

retrieving a plurality of monitoring sets from a database which each comprise recorded measures relating to patient information recorded on a substantially continuous basis;

determining a patient status change in response to an atrial fibrillation diagnosis by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

testing each patient status change against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation.

31. An automated collection and analysis patient care system for diagnosing and monitoring the outcomes of atrial fibrillation, comprising:

a database storing a plurality of monitoring sets, each monitoring set comprising recorded measures which each relate to patient information and comprise either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;

a set of stored indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation and relating to the same type of patient information as at least one of the recorded measures; and

a diagnostic module diagnosing an atrial fibrillation finding, comprising;

an analysis module determining a change in patient status in response to an atrial fibrillation diagnosis by comparing at least one recorded measure to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

a comparison module comparing each patient status change to the indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

32. A system according to claim 31, wherein the device measures are recorded by at least one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded.

33. A system according to claim 31, wherein each of the monitoring sets comprises recorded measures relating to patient information solely for the individual patient, further comprising:

a database module retrieving each monitoring set from a patient care record for the individual patient and obtaining the at least one recorded measure and the at least one other recorded measure from the retrieved monitoring sets.

34. A system according to claim 31, wherein each of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, further comprising:

a database module retrieving at least one monitoring set from a patient care record for the individual patient, retrieving at least one other monitoring set from a patient care record in the same patient peer group, and obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

35. A system according to claim 31, wherein each of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, further comprising:

a database module retrieving at least one monitoring set from a patient care record for the individual patient, retrieving at least one other monitoring set from a patient care record in the overall patient population, and obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

36. A system according to claim 31, further comprising:

the database further storing a reference baseline comprising recorded measures which each relate to patient information recorded by the medical device adapted to be implanted during an initial time period and comprise either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and

a database module obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

37. A system according to claim 36, wherein the reference baseline comprises recorded measures relating to patient information for one of the individual patients solely, a peer group of patients to which the individual patient belongs, and a general population of patients.

38. A system according to claim 31, the comparison module further comprising:

a module grading the comparisons between each patient status change and corresponding indicator threshold on a fixed scale based on a degree of deviation from the indicator threshold; and

the comparison module determining an overall patient status change by performing a summation over the individual graded comparisons.

39. A system according to claim 31, the comparison module further comprising:

a module determining probabilistic weightings of the comparisons between each patient status change and corresponding indicator threshold based on a statistical deviation and trends via linear fits from the indicator threshold; and

the comparison module determining an overall patient status change by performing a summation over the individual graded comparisons.

40. A system according to claim 31, wherein each monitoring set further comprises quality of life and symptom measures recorded by the individual patient, the diagnostic module further comprising:

a quality of life module determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure; and

the diagnostic module incorporating each patient status change in quality of life into the atrial fibrillation finding to either refute or support the diagnosis.

41. A system according to claim 31, further comprising:

a set of stored further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation; and

the diagnostic module diagnosing a finding of a disease other than atrial fibrillation, the comparison module further comprising comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure.

42. A system according to claim 31, further comprising:

a set of stickiness indicators, each indicator threshold corresponding to a temporal limit related to a course of patient care; and

a feedback module comparing a time span between each patient status change for each recorded measure to the stickiness indicator corresponding to the same type of patient information as the recorded measure being compared.

43. A system according to claim 31, further comprising:

a feedback module providing automated feedback to the individual patient when an atrial fibrillation finding is indicated.

44. A system according to claim 43, further comprising:

the feedback module performing an interactive dialogue between the individual patient and the patient care system regarding a medical condition of the individual patient.

46. A method according to claim 45, wherein the device measures are recorded by at least one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded.

47. A method according to claim 46, wherein each of the monitoring sets comprises recorded measures relating to patient information solely for the individual patient, further comprising:

retrieving each monitoring set from a patient care record for the individual patient; and

obtaining the at least one recorded measure and the at least one other recorded measure from the retrieved monitoring sets.

48. A method according to claim 45, wherein each of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, further comprising:

retrieving at least one monitoring set from a patient care record for the individual patient;

retrieving at least one other monitoring set from a patient care record in the same patient peer group; and

obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

49. A method according to claim 45, wherein each of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, further comprising:

retrieving at least one monitoring set from a patient care record for the individual patient;

retrieving at least one other monitoring set from a patient care record in the overall patient population; and

obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

50. A method according to claim 45, further comprising:

retrieving a reference baseline comprising recorded measures which each relate to patient information recorded by the medical device adapted to be implanted during an initial time period and comprise either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and

obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

51. A method according to claim 50, wherein the reference baseline comprises recorded measures relating to patient information for one of the individual patients solely, a peer group of patients to which the individual patient belongs, and a general population of patients.

52. A method according to claim 45, the operation of comparing each patient status change further comprising:

grading the comparisons between each patient status change and corresponding indicator threshold on a fixed scale based on a degree of deviation from the indicator threshold; and

determining an overall patient status change by performing a summation over the individual graded comparisons.

53. A method according to claim 45, the operation of comparing each patient status change further comprising:

determining probabilistic weightings of the comparisons between each patient status change and corresponding indicator threshold based on a statistical deviation and trends via linear fits from the indicator threshold; and

determining an overall patient status change by performing a summation over the individual graded comparisons.

54. A method according to claim 45, wherein each monitoring set further comprises quality of life and symptom measures recorded by the individual patient, the operation of diagnosing an atrial fibrillation finding further comprising:

determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure; and

incorporating each patient status change in quality of life into the atrial fibrillation finding to either refute or support the diagnosis.

55. A method according to claim 45, further comprising:

defining a set of further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation; and

diagnosing a finding of the disease other than atrial fibrillation, comprising comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure.

56. A method according to claim 45, further comprising:

defining a set of stickiness indicators, each indicator threshold corresponding to a temporal limit related to a course of patient care; and

comparing a time span between each patient status change for each recorded measure to the stickiness indicator corresponding to the same type of patient information as the recorded measure being compared.

57. A method according to claim 45, further comprising:

providing automated feedback to the individual patient when an atrial fibrillation finding is indicated.

58. A method according to claim 57, further comprising:

performing an interactive dialogue between the individual patient and the patient care system regarding a medical condition of the individual patient.

60. A storage medium according to claim 59, wherein each of the monitoring sets comprises recorded measures relating to patient information solely for the individual patient, further comprising:

retrieving each monitoring set from a patient care record for the individual patient; and

obtaining the at least one recorded measure and the at least one other recorded measure from the retrieved monitoring sets.

61. A storage medium according to claim 59, wherein each of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, further comprising:

retrieving at least one monitoring set from a patient care record for the individual patient;

retrieving at least one other monitoring set from a patient care record in the same patient peer group; and

obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

62. A storage medium according to claim 59, wherein each of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, further comprising:

retrieving at least one monitoring set from a patient care record for the individual patient;

retrieving at least one other monitoring set from a patient care record in the overall patient population; and

obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

63. A storage medium according to claim 59, further comprising:

retrieving a reference baseline comprising recorded measures which each relate to patient information recorded by the medical device adapted to be implanted during an initial time period and comprise either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and

obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

64. A storage medium according to claim 59, the operation of comparing each patient status change further comprising:

grading the comparisons between each patient status change and corresponding indicator threshold on a fixed scale based on a degree of deviation from the indicator threshold; and

determining an overall patient status change by performing a summation over the individual graded comparisons.

65. A storage medium according to claim 59, the operation of comparing each patient status change further comprising:

determining probabilistic weightings of the comparisons between each patient status change and corresponding indicator threshold based on a statistical deviation and trends via linear fits from the indicator threshold; and

determining an overall patient status change by performing a summation over the individual graded comparisons.

66. A storage medium according to claim 59, wherein each monitoring set further comprises quality of life and symptom measures recorded by the individual patient, the operation of diagnosing an atrial fibrillation finding further comprising:

determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure; and

incorporating each patient status change in quality of life into the atrial fibrillation finding to either refute or support the diagnosis.

67. A storage medium according to claim 59, further comprising:

defining a set of further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation; and

diagnosing a finding of the disease other than atrial fibrillation, comprising comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure.

68. A storage medium according to claim 59, further comprising:

defining a set of stickiness indicators, each indicator threshold corresponding to a temporal limit related to a course of patient care; and

comparing a time span between each patient status change for each recorded measure to the stickiness indicator corresponding to the same type of patient information as the recorded measure being compared.

69. A storage medium according to claim 59, further comprising:

providing automated feedback to the individual patient when an atrial fibrillation finding is indicated.

70. A storage medium according to claim 69, further comprising:

performing an interactive dialogue between the individual patient and the patient care system regarding a medical condition of the individual patient.

45. A method for diagnosing and monitoring the outcomes of atrial fibrillation using an automated collection and analysis patient care system, comprising:

retrieving a plurality of monitoring sets from a database, each monitoring set comprising recorded measures which each relate to patient information and comprise either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;

defining a set of indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation and relating to the same type of patient information as at least one of the recorded measures; and

diagnosing an atrial fibrillation finding, comprising;

determining a change in patient status in response to an atrial fibrillation diagnosis by comparing at least one recorded measure to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

comparing each patient status change to the indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

59. A computer-readable storage medium holding code for diagnosing and monitoring the outcomes of atrial fibrillation using an automated collection and analysis patient care system, comprising:

retrieving a plurality of monitoring sets from a database, each monitoring set comprising recorded measures which each relate to patient information and comprise either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;

defining a set of indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation and relating to the same type of patient information as at least one of the recorded measures; and

diagnosing an atrial fibrillation finding, comprising;

determining a change in patient status in response to an atrial fibrillation diagnosis by comparing at least one recorded measure to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

comparing each patient status change to the indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

71. An automated patient care system for diagnosing and monitoring the outcomes of atrial fibrillation, comprising:

a database storing recorded measures organized into a monitoring set for an individual patient with each recorded measure having been recorded on a substantially continuous basis and relating to at least one of monitoring reduced exercise capacity and respiratory distress;

a database module periodically retrieving a plurality of the monitoring sets from the database; and

a diagnostic module evaluating at least one of atrial fibrillation onset, progression, regression, and status quo, comprising;

a comparison module determining a patient status change in response to an atrial fibrillation diagnosis by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

an analysis module testing each patient status change against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of reduced exercise capacity and respiratory distress.

72. A method for diagnosing and monitoring the outcomes of atrial fibrillation in an automated patient care system, comprising:

storing recorded measures organized into a monitoring set for an individual patient into a database with each recorded measure having been recorded on a substantially continuous basis and relating to at least one of monitoring reduced exercise capacity and respiratory distress;

periodically retrieving a plurality of the monitoring sets from the database;

evaluating at least one of atrial fibrillation onset, progression, regression, and status quo, comprising;

determining a patient status change in response to an atrial fibrillation diagnosis by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

testing each patient status change against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of reduced exercise capacity and respiratory distress.

73. A computer-readable storage medium holding code for diagnosing and monitoring the outcomes of atrial fibrillation in an automated patient care system, comprising:

storing recorded measures organized into a monitoring set for an individual patient into a database with each recorded measure having been recorded on a substantially continuous basis and relating to at least one of monitoring reduced exercise capacity and respiratory distress;

periodically retrieving a plurality of the monitoring sets from the database;

evaluating at least one of atrial fibrillation onset, progression, regression, and status quo, comprising;

determining a patient status change in response to an atrial fibrillation diagnosis by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

testing each patient status change against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of reduced exercise capacity and respiratory distress.

74. An automated system for managing a pathophysiological outcome of atrial fibrillation, comprising:

a database storing a plurality of monitoring sets from a database which each comprise recorded measures relating to patient information recorded on a substantially continuous basis;

a comparison module determining a pathophysiological outcome of atrial fibrillation in response to an atrial fibrillation diagnosis, comprising comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information and testing each recorded measure comparison against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation; and

an analysis module managing the atrial fibrillation outcome through interventive administration of therapy contributing to normal sinus rhythm restoration and ventricular rate response control.

75. An automated system according to claim 74, wherein the pathophysiological outcome comprises a cardiovascular/cardiopulmonary compromise, further comprising:

the comparison module classifying a severity of the cardiovascular/cardiopulmonary compromise according to magnitude of change and time span occurrence for each recorded measure comparison; and

the analysis module generating a therapy regimen based on the severity, comprising, in decreasing order of severity;

for the cardiovascular/cardiopulmonary compromise with a highest severity, administering an aggressive atrial fibrillation therapy;

for the cardiovascular/cardiopulmonary compromise of second highest severity, administering initial anticoagulation management coupled with selective ventricular rate response control for atrial fibrillation of long term duration and administering an aggressive atrial fibrillation therapy in the presence of anticoagulation drug therapy;

for the cardiovascular/cardiopulmonary compromise of third highest severity, administering initial monitored anticoagulation management coupled with selective ventricular rate response control for atrial fibrillation of long term duration, administering a moderate atrial fibrillation therapy coupled with ventricular rate response control for atrial fibrillation of long term duration and administering a moderate atrial fibrillation therapy for atrial fibrillation in the absence of anticoagulation drug therapy; and

for the cardiovascular/cardiopulmonary compromise of least severity, administering initial anticoagulation management coupled with selective ventricular rate response control and on-going cardiovascular/cardiopulmonary monitoring for atrial fibrillation of long term duration, administering a modest atrial fibrillation therapy for atrial fibrillation of long term duration and administering a modest atrial fibrillation therapy for atrial fibrillation in the absence of anticoagulation drug therapy.

76. An automated system according to claim 74, wherein the pathophysiological outcome comprises an inappropriate ventricular rate response, further comprising:

the comparison module classifying ventricular rate response according to average ventricular rate; and

the analysis module generating a therapy regimen based on the severity, comprising;

for overly slow ventricular rate response, performing at least one therapy selected from the group comprising increasing ventricular pacing rate and decreasing antidromotropic drug therapy; and

for overly rapid ventricular rate response, performing at least one therapy selected from the group comprising applying electrical therapy and administering initial drug therapy to decrease atrioventricular node conduction.

77. An automated system according to claim 74, wherein the pathophysiological outcome comprises a pathophysiological condition requiring anticoagulation drug therapy, further comprising:

the comparison module determining a duration for atrial fibrillation and anticoagulation drug therapy status; and

the analysis module administering anticoagulation drug therapy for atrial fibrillation of long term duration in the absence of a contraindication of anticoagulation drug therapy or inadequacy thereof.

78. An automated system according to claim 74, wherein the pathophysiological outcome comprises palpitations/symptoms, further comprising:

the comparison module classifying palpitations/symptoms according to disabling effect to the patient; and

the analysis module generating a therapy regimen based on the classification, comprising;

for disabling palpitations/symptoms, administering a moderate atrial fibrillation therapy for atrial fibrillation;

for non-disabling palpitations/symptoms, administering a modest atrial fibrillation therapy for atrial fibrillation.

80. An automated method according to claim 79, wherein the pathophysiological outcome comprises a cardiovascular/cardiopulmonary compromise, further comprising:

classifying a severity of the cardiovascular/cardiopulmonary compromise according to magnitude of change and time span occurrence for each recorded measure comparison; and

generating a therapy regimen based on the severity, comprising, in decreasing order of severity;

for the cardiovascular/cardiopulmonary compromise with a highest severity, administering an aggressive atrial fibrillation therapy;

for the cardiovascular/cardiopulmonary compromise of second highest severity, administering initial anticoagulation management coupled with selective ventricular rate response control for atrial fibrillation of long term duration and administering an aggressive atrial fibrillation therapy in the presence of anticoagulation drug therapy;

for the cardiovascular/cardiopulmonary compromise of third highest severity, administering initial monitored anticoagulation management coupled with selective ventricular rate response control for atrial fibrillation of long term duration, administering a moderate atrial fibrillation therapy coupled with ventricular rate response control for atrial fibrillation of long term duration and administering a moderate atrial fibrillation therapy for atrial fibrillation in the absence of anticoagulation drug therapy; and

for the cardiovascular/cardiopulmonary compromise of least severity, administering initial anticoagulation management coupled with selective ventricular rate response control and on-going cardiovascular/cardiopulmonary monitoring for atrial fibrillation of long term duration, administering a modest atrial fibrillation therapy for atrial fibrillation of long term duration and administering a modest atrial fibrillation therapy for atrial fibrillation in the absence of anticoagulation drug therapy.

81. An automated method according to claim 79, wherein the pathophysiological outcome comprises an inappropriate ventricular rate response, further comprising:

classifying ventricular rate response according to average ventricular rate; and

generating a therapy regimen based on the severity, comprising;

for overly slow ventricular rate response, performing at least one therapy selected from the group comprising increasing ventricular pacing rate and decreasing antidromotropic drug therapy; and

for overly rapid ventricular rate response, performing at least one therapy selected from the group comprising applying electrical therapy and administering initial drug therapy to decrease atrioventricular node conduction.

82. An automated method according to claim 79, wherein the pathophysiological outcome comprises a pathophysiological condition requiring anticoagulation drug therapy, further comprising:

determining a duration for atrial fibrillation and anticoagulation drug therapy status; and

administering anticoagulation drug therapy for atrial fibrillation of long term duration in the absence of a contraindication of anticoagulation drug therapy or inadequacy thereof.

83. An automated method according to claim 79, wherein the pathophysiological outcome comprises palpitations/symptoms, further comprising:

classifying palpitations/symptoms according to disabling effect to the patient; and

generating a therapy regimen based on the classification, comprising;

for disabling palpitations/symptoms, administering a moderate atrial fibrillation therapy for atrial fibrillation;

for non-disabling palpitations/symptoms, administering a modest atrial fibrillation therapy for atrial fibrillation.

79. An automated method for managing a pathophysiological outcome of atrial fibrillation, comprising:

retrieving a plurality of monitoring sets from a database which each comprise recorded measures relating to patient information recorded on a substantially continuous basis;

determining a pathophysiological outcome of atrial fibrillation in response to an atrial fibrillation diagnosis, comprising;

comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

testing each recorded measure comparison against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation; and

managing the atrial fibrillation outcome through interventive administration of therapy contributing to normal sinus rhythm restoration and ventricular rate response control.

84. A computer-readable storage medium holding code for managing a pathophysiological outcome of atrial fibrillation, comprising:

retrieving a plurality of monitoring sets from a database which each comprise recorded measures relating to patient information recorded on a substantially continuous basis;

determining a pathophysiological outcome of atrial fibrillation in response to an atrial fibrillation diagnosis, comprising;

comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

testing each recorded measure comparison against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation; and

managing the atrial fibrillation outcome through interventive administration of therapy contributing to normal sinus rhythm restoration and ventricular rate response control.

85. A storage medium according to claim 84, wherein the pathophysiological outcome comprises a cardiovascular/cardiopulmonary compromise, further comprising:

classifying a severity of the cardiovascular/cardiopulmonary compromise according to magnitude of change and time span occurrence for each recorded measure comparison; and

generating a therapy regimen based on the severity, comprising, in decreasing order of severity;

for the cardiovascular/cardiopulmonary compromise with a highest severity, administering an aggressive atrial fibrillation therapy;

for the cardiovascular/cardiopulmonary compromise of second highest severity, administering initial anticoagulation management coupled with selective ventricular rate response control for atrial fibrillation of long term duration and administering an aggressive atrial fibrillation therapy in the presence of anticoagulation drug therapy;

for the cardiovascular/cardiopulmonary compromise of third highest severity, administering initial monitored anticoagulation management coupled with selective ventricular rate response control for atrial fibrillation of long term duration, administering a moderate atrial fibrillation therapy coupled with ventricular rate response control for atrial fibrillation of long term duration and administering a moderate atrial fibrillation therapy for atrial fibrillation in the absence of anticoagulation drug therapy; and

for the cardiovascular/cardiopulmonary compromise of least severity, administering initial anticoagulation management coupled with selective ventricular rate response control and on-going cardiovascular/cardiopulmonary monitoring for atrial fibrillation of long term duration, administering a modest atrial fibrillation therapy for atrial fibrillation of long term duration and administering a modest atrial fibrillation therapy for atrial fibrillation in the absence of anticoagulation drug therapy.

86. A storage medium according to claim 84, wherein the pathophysiological outcome comprises an inappropriate ventricular rate response, further comprising:

classifying ventricular rate response according to average ventricular rate; and

generating a therapy regimen based on the severity, comprising;

for overly slow ventricular rate response, performing at least one therapy selected from the group comprising increasing ventricular pacing rate and decreasing antidromotropic drug therapy; and

for overly rapid ventricular rate response, performing at least one therapy selected from the group comprising applying electrical therapy and administering initial drug therapy to decrease atrioventricular node conduction.

87. A storage medium according to claim 84, wherein the pathophysiological outcome comprises a pathophysiological condition requiring anticoagulation drug therapy, further comprising:

determining a duration for atrial fibrillation and anticoagulation drug therapy status; and

administering anticoagulation drug therapy for atrial fibrillation of long term duration in the absence of a contraindication of anticoagulation drug therapy or inadequacy thereof.

88. A storage medium according to claim 84, wherein the pathophysiological outcome comprises palpitations/symptoms, further comprising:

classifying palpitations/symptoms according to disabling effect to the patient; and

generating a therapy regimen based on the classification, comprising;

for disabling palpitations/symptoms, administering a moderate atrial fibrillation therapy for atrial fibrillation;

for non-disabling palpitations/symptoms, administering a modest atrial fibrillation therapy for atrial fibrillation.