System And Method For Automated Diagnosis Of Atrial Fibrillation Through Remote Monitoring

• US 20080051668A1
• Filed: 10/31/2007
• Published: 02/28/2008
• Est. Priority Date: 11/16/1999
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Bardy, Gust
• Granted Patent: US 8,874,200 B2
• Time in Patent Office: Days
• US Class Current: 600/483
• 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

A system and method for automated diagnosis of atrial fibrillation through remote monitoring is described. Physiological measures including data either recorded on a regular basis by a medical device or derived therefrom are stored. Physiological measures recorded during a baseline period are identified. Physiological measures including cardiac rhythm and changes to the cardiac rhythm originating subsequent to the baseline period are identified. Cardiac rhythm changes for palpitations are evaluated and a time course for the cardiac rhythm changes upon an indication of palpitations is determined. A patient status including an onset of atrial fibrillation conditioned on the time course comprising a short duration is formed.

Claims

1. A system for automated assessment of stroke risk through remote monitoring, comprising:

a database module storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

a comparison module identifying the physiological measures comprising cardiac rhythm and changes to the cardiac rhythm occurring over a set time frame;

an analysis module evaluating the cardiac rhythm changes and determining a time course for the cardiac rhythm changes during the set time frame; and

a diagnostic module generating an alert of potential stroke risk comprising an onset of atrial fibrillation conditioned on the time course enduring over the set time frame on a continuing extended basis.

2. A system according to claim 1 wherein the analysis module further specifies the set time period as a 48-hour period within a one week time frame.

3. A system according to claim 1, wherein the comparison module further identifies the physiological measures recorded during a baseline period, and further identifies the cardiac rhythm changes originating subsequent to the baseline period;

and the analysis module further evaluates the cardiac rhythm changes over the set time frame relative to die baseline period.

4. A method for automated assessment of stroke risk through remote monitoring, comprising:

storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

identifying the physiological measures comprising cardiac rhythm and changes to the cardiac rhythm occurring over a set time frame;

evaluating the cardiac rhythm changes and determining a time course for the cardiac rhythm changes during the set time frame; and

generating an alert of potential stroke risk comprising an onset of atrial fibrillation conditioned on the time course enduring over the set time frame on a continuing extended basis.

5. A method according to claim 4, further comprising:

specifying the set time period as a 48-hour period within a one week time frame.

6. A method according to claim 4, further comprising:

identifying the physiological measures recorded during a baseline period;

identifying the cardiac rhythm changes originating subsequent to the baseline period; and

evaluating the cardiac rhythm changes over the set time frame relative to the baseline period.

7. A system for automated diagnosis of atrial fibrillation through remote monitoring, comprising:

a database module storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

a comparison module identifying the physiological measures comprising cardiac rhythm and changes to the cardiac rhythm occurring over a set time frame; and

an analysis module evaluating the cardiac rhythm changes and categorizing the cardiac rhythm changes by form of atrial fibrillation relative to type, sequence, and the non-identified physiological measures.

8. A system according to claim 7, further comprising:

a diagnostic module determining a therapy direction indicated by the form of atrial fibrillation comprising one of restoring normal sinus rhythm and terminating the atrial fibrillation.

9. A method for automated diagnosis of atrial fibrillation through remote monitoring, comprising:

storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

identifying the physiological measures comprising cardiac rhythm and changes to the cardiac rhythm occurring over a set time frame; and

evaluating the cardiac rhythm changes and categorizing the cardiac rhythm changes by form of atrial fibrillation relative to type, sequence, and the no-identified physiological measures.

10. A method according to claim 9, further comprising:

determining a therapy direction indicated by the form of atrial fibrillation comprising one of restoring normal sinus rhythm and terminating the atrial fibrillation.

11. A system for automated diagnosis of atrial arrhythmia through remote monitoring, comprising:

a database module storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

a comparison module identifying the physiological measures comprising cardiac rhythm;

an analysis module determining a burden represented by the cardiac rhythm in respect of one or more of reduced exercise capacity, respiratory distress, and palpitations; and

a diagnostic module forming a patient status comprising a form of atrial arrhythmia reflected by the burden.

12. A system according to claim 11, wherein the analysis module further evaluates the burden against a symptomatology selected from the group comprising myocardial ischemia, respiratory insufficiency, pneumonia, exacerbation of chronic bronchitis, renal failure, sleep-apnea, stroke, anemia, and cardiac arrhythmias.

13. A method for automated diagnosis of atrial arrhythmia through remote monitoring, comprising:

storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

identifying the physiological measures comprising cardiac rhythm;

determining a burden represented by the cardiac rhythm in respect of one or more of reduced exercise capacity, respiratory distress, and palpitations; and

forming a patient status comprising a form of atrial arrhythmia reflected by the burden.

14. A method according to claim 13, further comprising:

evaluating the burden against a symptomatology selected from the group comprising myocardial ischemia, respiratory insufficiency, pneumonia, exacerbation of chronic bronchitis, renal failure, sleep-apnea, stroke, anemia, and cardiac arrhythmias.

15. A system for automated diagnosis of atrial fibrillation through remote monitoring, comprising:

a database module storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

a comparison module identifying the physiological measures recorded during a baseline period, and identifying the physiological measures comprising cardiac rhythm and changes to the cardiac rhythm originating subsequent to the baseline period;

an analysis module evaluating the cardiac rhythm changes for palpitations and determining a time course for the cardiac rhythm changes upon an indication of palpitations; and

a diagnostic module forming a patient status comprising an onset of atrial fibrillation conditioned on the time course comprising a short duration.

16. A system according to claim 15, wherein the comparison module further identifies changes to at least one of cardiac output and pulmonary artery diastolic pressure, originating subsequent to the baseline period, conditioned on the time course comprising other than a short duration;

the analysis module respectively further evaluates the cardiac output changes and the pulmonary artery diastolic pressure changes for reduced exercise capacity and respiratory distress; and

the diagnostic module further forms a patient status, by setting an asymptomatic condition upon an indication of palpitations and an absence of both reduced exercise capacity and respiratory distress, and setting an asymptomatic condition upon an indication of at least one of reduced exercise capacity and respiratory distress and an absence of palpitations.

17. A system according to claim 16, wherein the analysis module further assigns a scaled index value correlating with a relative severity to each of the physiological measures, further increases the scaled index values assigned to the cardiac rhythm changes, cardiac output changes, and pulmonary artery diastolic pressure changes, and further analyzes the scaled index values;

and the diagnostic module further forms a patient status, by setting an onset of atrial fibrillation upon a high scaled index value for palpitations and any scaled index values for reduced exercise capacity and respiratory distress, setting an onset of atrial fibrillation upon a medium scaled index value for palpitations and at least medium scaled index values for reduced exercise capacity or respiratory distress, and setting an asymptomatic condition upon a low scaled index value for palpitations and any scaled index values for reduced exercise capacity and respiratory distress.

18. A method for automated diagnosis of atrial fibrillation through remote monitoring, comprising:

storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

identifying the physiological measures recorded during a baseline period;

identifying the physiological measures comprising cardiac rhythm and changes to the cardiac rhythm originating subsequent to the baseline period;

evaluating the cardiac rhythm changes for palpitations and determining a time course for the cardiac rhythm changes upon an indication of palpitations; and

forming a patient status comprising an onset of atrial fibrillation conditioned on the time course comprising a short duration.

19. A method according to claim 18, further comprising:

identifying changes to at least one of cardiac output and pulmonary artery diastolic pressure, originating subsequent to the baseline period, conditioned on the time course comprising other than a short duration;

respectively evaluating the cardiac output changes and the pulmonary artery diastolic pressure changes for reduced exercise capacity and respiratory distress; and

forming a patient status, comprising;

setting an asymptomatic condition upon an indication of palpitations and an absence of both reduced exercise capacity and respiratory distress; and

setting an asymptomatic condition upon an indication of at least one of reduced exercise capacity and respiratory distress and an absence of palpitations.

20. A method according to claim 19, further comprising:

assigning a scaled index value correlating with a relative severity to each of the physiological measures;

increasing the scaled index values assigned to the cardiac rhythm changes, cardiac output changes, and pulmonary artery diastolic pressure changes;

analyzing the scaled index values; and

forming a patient status, comprising;

setting an onset of atrial fibrillation upon a high scaled index value for palpitations and any scaled index values for reduced exercise capacity and respiratory distress;

setting an onset of atrial fibrillation upon a medium scaled index value for palpitations and at least medium scaled index values for reduced exercise capacity or respiratory distress; and

setting an asymptomatic condition upon a low scaled index value for palpitations and any scaled index values for reduced exercise capacity and respiratory distress.

21. A system for evaluating cardiac rhythm through remote patient monitoring, comprising:

a database module storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

a comparison module identifying the physiological measures comprising cardiac rhythm;

an analysis module analyzing the cardiac rhythm, by specifying type and sequence of changes to the cardiac rhythm occurring over a set time frame, and evaluating changes to the non-identified physiological measures occurring over the same set time frame relative to the type and sequence of the cardiac rhythm changes; and

a diagnostic module determining a therapy direction indicated by the evaluation of the cardiac rhythm and not identified physiological measures.

22. A system according to claim 21, wherein the nor identified physiological measures comprise circulatory measures, wherein the analysis module further specifies type and sequence of changes to the circulatory measures occurring over the same set time frame;

and the diagnostic module further sets the therapy direction as counter indicated by an atrial fibrillation finding conditioned upon the circulatory measures changes precipitating the cardiac rhythm changes.

23. A method for evaluating cardiac rhythm through remote patient monitoring, comprising:

storing physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom;

identifying the physiological measures comprising cardiac rhythm;

analyzing the cardiac rhythm, comprising;

specifying type and sequence of changes to the cardiac rhythm occurring over a set time frame; and

evaluating changes to the nor identified physiological measures occurring over the same set time frame relative to the type and sequence of the cardiac rhythm changes; and

determining a therapy direction indicated by the evaluation of the cardiac rhythm and non-identified physiological measures.

24. A method according to claim 23, wherein the non-identified physiological measures comprise circulatory measures, further comprising:

specifying type and sequence of changes to the circulatory measures occurring over the same set time frame; and

setting the therapy direction as counter indicated by an atrial fibrillation finding conditioned upon the circulatory measures changes precipitating the cardiac rhythm changes.