System And Method For Monitoring a Patient Status

• US 20140135637A1
• Filed: 01/23/2014
• Published: 05/15/2014
• Est. Priority Date: 11/16/1999
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Bardy, Gust
• Application Number:
  US14/162,218
• Publication Number:
  US 20140135637A1
• Time in Patent Office: Days
• US Class Current: 600/509
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• 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: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02438 with portable devices, e.g. worn by the patient
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/486 Bio-feedback A61B5/375 takes precedence
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A system and method for automated diagnosis of myocardial ischemia through remote monitoring is described. Physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom is stored. Qualitative measures associated with the physiological measures are matched. Indications of myocardial ischemia are remotely identified. The qualitative measures for both of a reduction in exercise capacity and respiratory distress occurring contemporaneously are examined. The qualitative measures for angina that accompanies the reduction in exercise capacity and the respiratory distress are evaluated. A time course for each of the indications is determined. A patient status is formed comprising an onset of myocardial ischemia conditioned on the time course comprising a short duration.

Claims

1. A system for monitoring a patient status, comprising:

a medical device configured to record patient physiological measures on a regular basis, wherein the physiological measures comprise at least impedance measurements;

a database module storing the physiological measures comprising a reference baseline data set and a monitoring set of data recorded by the medical device subsequently to the reference baseline data set;

a processor configured to calculate the average of each physiological measure in the monitoring set;

a comparison module configured to compare the average of each physiological measure in the monitoring set to the reference baseline;

a diagnostic module configured to determine a patient status indicator comprising an indication of a change in patient status; and

a feedback module configured to provide automated feedback based on the patient status indicator.

2. A system according to claim 1, further comprising an analysis module configured to compare each of the physiological measures against an indicator threshold comprising one of a finite cutoff value, weighted value, and statistical range, and further evaluate a potential onset, progression, regression, and status quo of myocardial ischemia based on findings of the indicator threshold comparisons.

3. A system according to claim 2, wherein the analysis module further assigns the weighted value comprising a highest weight to wall motion abnormalities in the reduction in exercise capacity and respiratory distress examinations.

9. The system according to claim 2, wherein the analysis module further assigns the weighted value comprising a highest weight to an ST segment elevation in the angina examination.

13. A system of claim 1, further comprising:

an analysis module configured to determine indications of cardiac ischemia, by identifying the physiological measures that comprise electrocardial signals and detect a period of increased activity indicated thereby, and determine a deviation in electrical potential during an ST segment of the electrocardial signal within the period of increased activity;

wherein the diagnostic module is configured to determine the patient status indicator based on the deviation.

14. A system according to claim 13, wherein the analysis module further evaluates the deviation for one of an elevated potential and a depressed potential during the ST segment and further specifies the elevated potential as an indicator of the cardiac ischemia, wherein the form comprises myocardial ischemia.

15. A system according to claim 14, wherein the analysis module further confirms an absence of QRS duration of the electrocardial signal greater than 120 ms, and further declares the elevation of the ST segment as an a priori indicator of the myocardial ischemia when exceeding 2.0 mm.

25. A system of claim 1, further comprising an analysis module, wherein the analysis module is configured to periodically receive and compare one or more updated physiological measures to an indicator threshold to determine a patient status change over a time period, wherein the database is further configured to periodically receive the updated physiological measures;

and

a feedback module configured to indicate whether changes to the therapy are appropriate based on the patient status change over the time period.

26. The system of claim 25, wherein the received updated physiological measures comprise data associated with patient therapy outcomes.

27. The system of claim 1, wherein the monitoring set of data comprises data associated with patient therapy outcomes.

4. A method for monitoring a patient status, comprising:

recording patient physiological measures on a regular basis, wherein the physiological measures comprise at least impedance measurements;

storing physiological measures in data sets comprising a reference baseline data set and one or more monitoring sets of data each recorded by the medical device subsequently to the reference baseline data set;

calculating, by a processor, the average of each physiological measure in the monitoring set;

comparing, by a comparison module, the average of each physiological measure in the monitoring set to the reference baseline;

forming a patient status indicator, by a diagnostic module, comprising an indication of a change in patient status; and

providing automated feedback based on the patient status indicator.

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

comparing each of the physiological measures against an indicator threshold comprising one of a finite cutoff value, weighted value, and statistical range; and

evaluating a potential onset, progression, regression, and status quo of myocardial ischemia based on findings of the indicator threshold comparisons.

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

assigning the weighted value comprising a highest weight to wall motion abnormalities in the reduction in exercise capacity and respiratory distress examinations.

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

assigning the weighted value comprising a highest weight to an ST segment elevation in the angina examination.

16. A method of claim 4, further comprising:

determining indications of cardiac ischemia, comprising;

identifying the physiological measures that comprise electrocardial signals and detecting a period of increased activity indicated thereby; and

determining a deviation in electrical potential during an ST segment of the electrocardial signal within the period of increased activity; and

forming the patient status indicator comprising a form of cardiac ischemia based on the deviation.

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

evaluating the deviation for one of an elevated potential and a depressed potential during the ST segment; and

specifying the elevated potential as an indicator of the cardiac ischemia, wherein the form comprises myocardial ischemia.

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

confirming an absence of QRS duration of the electrocardial signal greater than 120 ms; and

declaring the elevation of the ST segment as an a priori indicator of the myocardial ischemia when exceeding 2.0 mm.

28. The method of claim 4, further comprising:

periodically receiving one or more physiological measures and comparing, by a comparison module, the one or more physiological measures to an indicator threshold to determine a patient status change over a time period; and

indicating, by a feedback module, whether changes to the therapy are appropriate based on the patient status change over the time period.

29. The method of claim 28, wherein the updated physiological measures comprise data associated with patient therapy outcomes.

30. The method of claim 4, wherein the one or more monitoring sets comprise data associated with patient therapy outcomes.

7-8. -8. (canceled)

10-11. -11. (canceled)

19-24. -24. (canceled)