METHODS FOR GUIDING HEART FAILURE DECOMPENSATION THERAPY

• US 20110077616A1
• Filed: 09/30/2009
• Published: 03/31/2011
• Est. Priority Date: 09/30/2009
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Cho, Yong K., Bennett, Tommy D.
• Granted Patent: US 9,943,236 B2
• Time in Patent Office: Days
• US Class Current: 604/503
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61M 2205/054 with electrotherapy
• CPC Class Codes: A61M 2210/125 Heart
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/3655 controlled by body or blood temperature
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network

Abstract

An implantable medical device system and associated method for use in guiding an acute decompensated heart failure therapy set an optimal fluid status measurement level. A physiological sensor signal sensed by an implantable medical device is used to compute the fluid status measurement. A target rate of change of the fluid status measurement is computed for guiding the therapy.

Claims

1. A method, comprising:

setting an optimal fluid status measurement level;

sensing a physiological sensor signal and computing a fluid status measurement and an actual rate of change of the fluid status measurement from the sensor signal;

administering a therapy;

computing a target rate of change of the fluid status measurement using a fluid status measurement and the optimal fluid status measurement level; and

generating a notification if the actual rate of change of the fluid status measurement subsequent to initiating the administered therapy does not match the target rate of change.

2. The method of claim 1 further comprising displaying the computed fluid status measurement over time.

3. The method of claim 1 wherein setting the optimal fluid status measurement level comprises:

storing a fluid status measurement corresponding to acute decompensated heart failure events; and

computing the optimal fluid status measurement level in response to the stored fluid status measurement.

4. The method of claim 1 wherein setting the optimal fluid status measurement level comprises using a distribution of previously computed fluid status measurements.

5. The method of claim 1 wherein sensing the physiological sensor signal comprises sensing one of an impedance signal and a blood pressure signal.

6. The method of claim 1 wherein computing the target rate of change of the fluid status measurement comprises establishing a duration of the therapy and a target change in the fluid status measurement during the duration of the therapy.

7. The method of claim 1 further comprising automatically adjusting the therapy administration in response to exceeding the target rate.

8. The method of claim 1 further comprising adjusting the therapy administration to maintain the actual rate of change of the fluid status measurement within a range of the target rate of change.

9. The method of claim 8 wherein adjusting the therapy administration to maintain the rate of change of the fluid status measurement comprises adjusting the therapy to prevent the fluid status measurement from falling below the optimal level.

10. The method of claim 1 wherein the therapy comprises intravenous infusion of one of a diuretic and a vasodilator.

11. The method of claim 1 wherein computing the target rate of change comprises computing a first target rate of change over a first time period and second target rate of change over a second time period, the second target rate of change being different than the first target rate of change.

12. The method of claim 11 wherein the second target rate of change is slower than the first target rate of change and further comprising adjusting the therapy to maintain the actual rate of change within a range of the second target rate of change after the computed fluid status measurement reaches an intermediate fluid status measurement greater than the optimal fluid status measurement level.

13. An implantable medical device system, comprising:

a sensor sensing a physiological signal;

a processor computing a fluid status measurement and computing a target rate of change of the fluid status measurement using the physiological signal;

a therapy delivery device for delivering a heart failure therapy; and

a control unit configured to establish an optimal fluid status measurement level, compute a target rate of change of the fluid status measurement using a fluid status measurement and the optimal fluid status measurement level, and generate a notification if the actual rate of change does not match the target rate.

14. The system of claim 13 further comprising a display and wherein the control unit is further configured to display the computed fluid status measurement over time on the display.

15. The system of claim 13 wherein establishing the optimal fluid status measurement level comprises:

storing a previous fluid status measurement corresponding to an acute decompensated heart failure event;

computing the optimal fluid status measurement level using the stored fluid status measurement.

16. The system of claim 13 wherein setting the optimal fluid status measurement level comprises using a distribution of previously computed fluid status measurements.

17. The system of claim 13 wherein the sensor comprises one of a pressure sensor and an impedance sensor.

18. The system of claim 13 wherein computing a target rate of change of the fluid status measurement comprises establishing a duration of the therapy and a target change in the fluid status measurement during the duration of the therapy.

19. The system of claim 13 wherein the control unit is further configured to automatically adjust the therapy delivery device in response to the target rate.

20. The system of claim 19 wherein the control unit is further configured to automatically adjust the therapy delivery device to maintain the actual rate of change of the fluid status measurement within a range of the target rate of change.

21. The system of claim 19 wherein the control unit is further configured to automatically adjust the therapy delivery device to prevent the fluid status measurement from falling below the optimal fluid status measurement level.

22. The system of claim 13 wherein the therapy delivery device comprises an infusion pump for delivering one of a diuretic and a vasodilator.

23. The system of claim 13 wherein computing the target rate of change comprises computing a first target rate of change over a first time period and second target rate of change over a second time period, the second target rate of change being different than the first target rate of change.

24. The system of claim 23 wherein the second target rate of change is a slower rate of change than the first target rate of change,

wherein the control unit is further configured to control the therapy delivery device to maintain the actual rate of change within a range of the second target rate of change after the computed fluid status measurement reaches an intermediate fluid status measurement greater than the optimal fluid status measurement level.