Respiration as a Trigger for Therapy Optimization

• US 20090234240A1
• Filed: 01/20/2009
• Published: 09/17/2009
• Est. Priority Date: 01/22/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Kuenzler, Richard O., Rasmussen, Mary Jane, Layton, John, McCabe, Aaron, Hopper, Donald
• Granted Patent: US 9,079,033 B2
• Time in Patent Office: Days
• US Class Current: 600/529
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• 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 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37258 Alerting the patient
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

Changes in patient status are assessed based at least in part on respiration parameters. A user can make selections regarding alert criteria options to be used in assessing patient status. Respiration is implantably sensed and respiration data is stored by an implantable device. A respiration parameter, such as respiration rate, is measured from the respiration data. The change in patient status is assessed by comparing the respiration parameter to the configured alert criteria. If the comparison of the respiration parameter and the configured alert criteria indicates a significant change in patient status, an alert signal is generated.

Claims

1. A method of operating a medical system including an implantable cardiac device, the method comprising:

displaying options for alert criteria used to assess a change in patient status;

receiving selections regarding the alert criteria options;

configuring alert criteria for assessing the change in patient status based on the received selections;

implantably sensing respiration and storing respiration data;

measuring a respiration parameter from the respiration data;

assessing the change in patient status including comparing the respiration parameter to the configured alert criteria; and

generating a signal indicating the change in patient status responsive to the comparison.

2. The method of claim 1, wherein generating the signal indicating the change in patient status comprises generating the signal according to a periodic schedule or generating the signal in real-time.

3. The method of claim 1, further comprising:

implantably measuring at least one additional physiological parameter and storing data related to the additional physiological parameter; and

comparing both the additional physiological parameter data and the respiration parameter to the configured alert criteria.

4. The method of claim 3, wherein the additional physiological parameter comprises a physiological parameter related to left ventricular function.

5. The method of claim 1, further comprising assessing therapy effectiveness based on the change in patient status.

6. The method of claim 1, wherein generating the alert signal comprises generating a multi-level alert indicating a criticality of the change in patient status or a need for therapy optimization.

7. The method of claim 1, further comprising initiating presentation of recommended therapy optimization options or automatically optimizing therapy responsive to the alert signal.

8. The method of claim 7, wherein the recommended therapy optimization options comprise a recommended change in pharmacological treatment.

9. The method of claim 7, wherein the recommended therapy optimization options comprise a recommended change in device programming.

10. The method of claim 7, wherein the recommended therapy optimization options comprise a recommended change in a type of cardiac device used to deliver therapy.

11. A system for evaluating patient status, the system comprising:

input and output circuitry configured to display alert criteria options and to receive selections regarding the alert criteria options;

sensors configured to implantably sense one or more physiological signals, including respiration;

circuitry configured to measure one or more parameters of the physiological signals, the measured parameters including respiration rate; and

an alert module configured to compare the measured parameters to the alert criteria and to generate an alert signal based on the comparison.

12. The system of claim 11, wherein the one or more parameters including the respiration rate comprises at least two of a maximum respiration rate, a minimum respiration rate, and a median respiration rate.

13. The system of claim 11, wherein the alert signal initiates analysis of therapy parameters and recommendations for modification of therapy parameters.

14. The system of claim 11, wherein the alert signal initiates automatic therapy optimization.

15. The system of claim 11, wherein the alert criteria is automatically modified based on the measured parameters.

16. The system of claim 11, wherein the alert module is configured to take into account contextual information before generating the alert.

17. The system of claim 11, further comprising a display configured to display parameter trends selected by a user for graphical representation.

18. The system of claim 17, wherein the parameter trends are correlated and displayed on a common time scale.

19. The system of claim 11, wherein additional data is input by a user via the input circuitry or automatically generated by the system and the additional data is appended to a database of parameter trends.

20. The system of claim 19, wherein the additional data is displayed as a marker on a graphical representation along with the parameter trends, the marker indicating a time associated with the additional data.

21. A medical system, comprising:

means for displaying options for alert criteria used to assess a change in patient status;

means for receiving selections regarding the alert criteria options;

means for configuring alert criteria for assessing the change in patient status based on the received selections;

means for implantably sensing respiration and storing respiration data;

means for measuring a respiration parameter from the respiration data;

means for comparing the respiration parameter to the configured alert criteria to assess the change in patient status; and

means for generating a signal indicating the change in patient status responsive to the comparison.

22. The system of claim 21, further comprising means for assessing therapy effectiveness.

23. The system of claim 21, further comprising means for presenting recommended therapy optimization options or automatically optimizing therapy responsive to the alert signal.