HEART FAILURE PATIENT MANAGEMENT USING AN IMPLANTABLE MONITORING SYSTEM

• US 20100113890A1
• Filed: 10/31/2008
• Published: 05/06/2010
• Est. Priority Date: 10/31/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Manda, Ven R., Sparks, Brandon S., Cho, Yong K., Bennett, Tommy D.
• Granted Patent: US 8,777,850 B2
• Time in Patent Office: Days
• US Class Current: 600/301
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• 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 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

An implantable medical device system and method provide physiological variable monitoring for use in patient management. A target value for a physiological variable and formulations for computing metrics of the physiological variable are stored. Values of the physiological variable are determined from a sensed physiological signal and are used to compute a selected metric. The metric is compared to the stored target value.

Claims

1. An implantable medical device, comprising;

a physiological sensor;

a memory storing a target value for a physiological variable and storing a plurality of formulations for computing a plurality of metrics of the physiological variable;

a control unit receiving a signal from the physiological sensor, computing a selected one of the plurality of metrics, and comparing the computed metric to the stored target value; and

a notification module generating a notice in response to the comparison of the computed metric and the target value.

2. The device of claim 1 wherein each of the plurality of formulations correspond to a time interval for computing the metric, wherein at least one formulation corresponds to a first time interval and another formulation corresponds to a second time interval greater than the first time interval.

3. The device of claim 1 wherein the control unit computes updated values of one of the plurality of metrics, and

the notification module generates reports of the computed updated metric values at predetermined time intervals after generating the notice.

4. The device of claim 1 wherein the notice comprises a time interval since a previous notice.

5. The device of claim 3 wherein the notification module receives an intervention initiated message, and

the control unit sets an intervention started flag in response to the received message.

6. The device of claim 5 wherein the notification module receives an intervention stopped message and generates reports of the updated metric values at predetermined time intervals until the intervention stopped notice is received.

7. The device of claim 1 wherein the physiological sensor is a pressure sensor.

8. The device of claim 2 wherein the physiological variable is an estimated pulmonary artery diastolic pressure (ePAD).

9. The device of claim 8 wherein the plurality of formulations comprise a daily average ePAD, a weekly average ePAD, and an exponentially weighted weekly average ePAD.

10. The device of claim 8 wherein the target value is 22 mmHg.

11. The device of claim 1 wherein the target value comprises a magnitude and a time duration.

12. The device of claim 1 wherein the memory stores the identity of the selected one of the plurality of metrics, and the notification module generates the notice only in response to the comparison of the selected metric and the target value.

13. The device of claim 1 further comprising a second sensor sensing a signal for measuring a secondary variable having a secondary affect on the physiological variable, wherein the plurality of formulations comprise a first formulation for computing the selected metric at a first level of the secondary variable and a second formulation for computing the selected metric at a second level greater than the first level of the secondary variable.

14. The device of claim 13 wherein the secondary variable is one of heart rate, activity, respiration rate, posture, and time of day.

15. The device of claim 1 wherein the control unit determines the target value in response to the sensed physiological signal.

16. A method for use in an implantable medical device system, comprising;

storing a target value for a physiological variable;

storing a plurality of formulations for computing a plurality of metrics of the physiological variable;

sensing a physiological signal;

computing a selected one of the plurality of metrics;

comparing the computed metric to the stored target value; and

generating a notice in response to the comparison of the computed metric and the target value.

17. The method of claim 16 wherein each of the plurality of formulations correspond to a time interval for computing the metric, wherein at least one formulation corresponds to a first time interval and another formulation corresponds to a second time interval greater than the first time interval.

18. The method of claim 16 further comprising computing updated values of one of the plurality of metrics;

and

generating a report of the computed updated metric values at predetermined time intervals after generating the notice.

19. The method of claim 16 wherein the notice comprises a time interval since a previous notice.

20. The method of claim 18 further comprising receiving an intervention initiated message, and

setting an intervention started flag in response to the received message.

21. The method of claim 20 further comprising:

receiving an intervention stopped message; and

generating the report at predetermined time intervals until the intervention stopped notice is received.

22. The method of claim 16 wherein the physiological signal is a pressure sensor.

23. The method of claim 22 wherein the physiological variable is an estimated pulmonary artery diastolic pressure (ePAD).

24. The method of claim 23 wherein the plurality of formulations comprise a daily average ePAD, a weekly average ePAD, and an exponentially weighted weekly average ePAD.

25. The method of claim 23 wherein the target value is 22 mmHg.

26. The method of claim 16 wherein the target value comprises a magnitude and a time duration.

27. The method of claim 16 wherein the memory stores the identity of the selected one of the plurality of metrics, and the notification module generates the notice only in response to the comparison of the selected metric and the target value.

28. The method of claim 16 further comprising:

sensing a signal for measuring a secondary variable having a secondary affect on the physiological variable,

wherein the plurality of formulations comprise a first formulation for computing the selected metric at a first level of the secondary variable and a second formulation for computing the selected metric at a second level greater than the first level of the secondary variable.

29. The method of claim 28 wherein the secondary variable is one of heart rate, activity, respiration rate, posture, and time of day.

30. The method of claim 16 further comprising determining the target value in response to the sensed physiological signal.

31. A computer readable medium for storing a set of instructions which when implemented in an implantable medical device system cause the system to:

store a target value for a physiological variable;

store a plurality of formulations for computing a plurality of metrics of the physiological variable;

sense a physiological signal;

compute a selected one of the plurality of metrics;

compare the computed metric to the stored target value; and

generate a notice in response to the comparison of the computed metric and the target value.