SYSTEM AND METHOD FOR EVALUATING A PATIENT STATUS FOR USE IN HEART FAILURE ASSESSMENT

• US 20140039327A1
• Filed: 10/14/2013
• Published: 02/06/2014
• Est. Priority Date: 06/03/1999
• 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 9,186,061 B2
• Time in Patent Office: Days
• US Class Current: 600/484
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: Y10S 128/92 Computer assisted medical diagnostics

Abstract

A system and method for evaluating a patient status from sampled physiometry for use in heart failure assessment is presented. Physiological measures are stored, including at least one of direct measures regularly recorded on a substantially continuous basis by an implantable medical device for a patient and measures derived from the direct measures. At least one of those of the physiological measures, which each relate to a same type of physiometry, and those of the physiological measures, which each relate to a different type of physiometry are sampled. A status for the patient is determined through analysis of the sampled physiological measures assembled from a plurality of recordation points. The sampled physiological measures are evaluated. Trends that are indicated by the patient status, which might affect cardiac performance of the patient, are identified. Each trend is compared to worsening heart failure indications to generate a notification of parameter violations.

Claims

1. A system for evaluating a patient status for use in heart failure assessment, comprising:

a data module to assemble physiological measures, which were directly recorded as data on a substantially continuous basis by an implantable medical device for a patient or indirectly derived from the data;

a status module to determine a status for the patient through sampling and analysis of the physiological measures over a plurality of data assembly points; and

an evaluation module to evaluate the physiological measures, comprising;

an analysis module to identify any trends that are indicated by the patient status; and

a comparison module to compare each such trend to worsening heart failure indications.

2. A system according to claim 1, further comprising:

a sampling module to form sampling sets, comprising at least one of;

a peer module to group a plurality of the physiological measures, which each relate to a same type of physiometry, into one or more peer measures sets; and

a sibling module to group a plurality of the physiological measures, which each relate to a different type of physiometry, into one or more sibling measures sets,

wherein one or more of the sampling sets is selected as the physiological measures.

3. A system according to claim 1, wherein physiological measures from one or more of the physiological measures for the patient, physiological measures for a peer group, and physiological measures for an overall patient population.

4. A system according to claim 1, further comprising:

a feedback module to provide tiered feedback from the patient status, comprising at least one of;

a first level module to communicate, at a first level, an interpretation of the patient status;

a second level module to communicate, at a second level, a notification of potential medical concern based on the patient status;

a third level module to communicate, at a third level, a notification of potential medical concern based on the patient status to medical personnel; and

a fourth level module to communicate, at a fourth level, a set of reprogramming instructions based on the patient status to an implantable medical device.

5. A system according to claim 1, wherein the worsening heart failure indications are selected from the group comprising pulmonary artery pressure, left atrial pressure, dyspnea, orthopnea, pulmonary edema, peripheral edema, and fatigue.

6. A system according to claim 1, further comprising:

a measurement module to measure one or more of pulmonary artery pressure, heart rate, heart sounds, intrathoracic impedance, respiration, posture, lung fluid, activity, weight, and physiological response to activity.

7. A system according to claim 1, further comprising:

a reprogramming module to reprogram an implantable medical device based on evaluation of the physiological measures.

8. A system according to claim 7, wherein the worsening heart failure indications are factored into the reprogramming.

9. A system according to claim 1, wherein respiration rate is tracked through the implantable medical device, further comprising:

a notification module to generate a notification triggered by a parameter assigned to the respiration rate.

10. A system according to claim 9, wherein the parameter comprises one or more of an upper limit parameter applied over a short term and a counter parameter applied over a long term.

11. A method for evaluating a patient status for use in heart failure assessment, comprising:

assembling physiological measures, which were directly recorded as data on a substantially continuous basis by an implantable medical device for a patient or indirectly derived from the data;

determining a status for the patient through sampling and analysis of the physiological measures over a plurality of data assembly points; and

identifying any trends that are indicated by the patient status and comparing each such trend to worsening heart failure indications.

12. A method according to claim 11, further comprising:

forming sampling sets, comprising at least one of;

grouping a plurality of the physiological measures, which each relate to a same type of physiometry, into one or more peer measures sets; and

grouping a plurality of the physiological measures, which each relate to a different type of physiometry, into one or more sibling measures sets; and

selecting one or more of the sampling sets as the physiological measures.

13. A method according to claim 11, further comprising:

including physiological measures from one or more of the physiological measures for the patient, physiological measures for a peer group, and physiological measures for an overall patient population.

14. A method according to claim 11, further comprising:

providing tiered feedback from the patient status, comprising at least one of;

at a first level, communicating an interpretation of the patient status;

at a second level, communicating a notification of potential medical concern based on the patient status;

at a third level, communicating a notification of potential medical concern based on the patient status to medical personnel; and

at a fourth level, communicating a set of reprogramming instructions based on the patient status to an implantable medical device.

15. A method according to claim 11, wherein the worsening heart failure indications are selected from the group comprising pulmonary artery pressure, left atrial pressure, dyspnea, orthopnea, pulmonary edema, peripheral edema, and fatigue.

16. A method according to claim 11, further comprising:

measuring one or more of pulmonary artery pressure, heart rate, heart sounds, intrathoracic impedance, respiration, posture, lung fluid, activity, weight, and physiological response to activity.

17. A method according to claim 11, further comprising:

reprogramming an implantable medical device based on evaluation of the physiological measures.

18. A method according to claim 17, further comprising:

factoring the worsening heart failure indications into the reprogramming.

19. A method according to claim 11, further comprising:

tracking respiration rate through the implantable medical device; and

generating a notification triggered by a parameter assigned to the respiration rate.

20. A method according to claim 19, wherein the parameter comprises one or more of an upper limit parameter applied over a short term and a counter parameter applied over a long term.

21. A system for evaluating a patient status from sampled physiometry for use in heart failure assessment, comprising:

a storage module to store physiological measures comprising at least one of direct measures regularly recorded on a substantially continuous basis by an implantable medical device for a patient and measures derived from the direct measures;

a sampling module to sample at least one of those of the physiological measures, which each relate to a same type of physiometry, and those of the physiological measures, which each relate to a different type of physiometry;

a status module to determine a status for the patient through analysis of those sampled physiological measures assembled from a plurality of recordation points; and

an evaluation module to evaluate the sampled physiological measures, comprising;

an analysis module to identify any trends that are indicated by the patient status, which might affect cardiac performance of the patient; and

a comparison module to compare each such trend to worsening heart failure indications to generate a notification of parameter violations.

22. A system according to claim 21, further comprising:

a reprogramming module to reprogram an implantable medical device based on extended evaluation of the direct measures and the derived measures.

23. A system according to claim 21, further comprising:

a tracking module to track respiration rate of the patient on a regular basis through the implantable medical device; and

a notification module to generate a notification triggered by one or more of an upper limit parameter applied over a short term and a counter parameter applied over a long term.

24. A method for evaluating a patient status from sampled physiometry for use in heart failure assessment, comprising:

storing physiological measures comprising at least one of direct measures regularly recorded on a substantially continuous basis by an implantable medical device for a patient and measures derived from the direct measures;

sampling at least one of those of the physiological measures, which each relate to a same type of physiometry, and those of the physiological measures, which each relate to a different type of physiometry;

determining a status for the patient through analysis of those sampled physiological measures assembled from a plurality of recordation points; and

evaluating the sampled physiological measures, comprising;

identifying any trends that are indicated by the patient status, which might affect cardiac performance of the patient; and

comparing each such trend to worsening heart failure indications to generate a notification of parameter violations.

25. A method according to claim 24, further comprising:

reprogramming an implantable medical device based on extended evaluation of the direct measures and the derived measures.

26. A method according to claim 24, further comprising:

tracking respiration rate of the patient on a regular basis through the implantable medical device; and

generating a notification triggered by one or more of an upper limit parameter applied over a short term and a counter parameter applied over a long term.