Implantable cardiac device for managing the progression of heart disease and method

• US 6,741,885 B1
• Filed: 07/17/2001
• Issued: 05/25/2004
• Est. Priority Date: 12/07/2000
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Mai, Junyu, Falkenberg, Eric, Bornzin, Gene A., Park, Euljoon
• Primary Examiner(s): Bockelman, Mark
• Application Number:
  US09/908,179
• Time in Patent Office: 1,043 Days
• Field of Search: 600/509, 600/529, 607/19, 607/20, 607/32
• US Class Current: 600/509
• 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 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585

Abstract

An implantable cardiac device detects a progression or regression in heart disease such as congestive heart failure. An activity sensor and a respiration sensor generate raw signals indicative of the patient'"'"'s activity level and respiration level. Degradation or improvement of the patient'"'"'s activity and respiration over a predetermined time corresponds to an indication of the progression or regression of the heart disease. A processor coupled to the sensors is programmed to process the raw sensor signals over the predetermined time and stores the processed sensor signals in a memory having a data storage area. A telemetry circuit coupled to the memory is configured to transmit the stored sensor signals to an external monitor for subsequent display. The processor further controls pacing of the heart, adjusts pacing therapy responsive to the process signals, and process the raw respiration signals when the patient is in a number of different active states.

Claims

1. An implantable cardiac device that monitors a progression or regression in congestive heart failure of a patient, during an extended time period, comprising:

an activity sensor that generates raw sensor signals indicative of the patient'"'"'s activity level, wherein a degradation or improvement of the patient'"'"'s activity level over time corresponds to an indication of the progression or regression of congestive heart failure;

a processor coupled to the activity sensor that processes the raw signals to determine activity measurements;

a memory coupled to the processor that stores the activity measurements during the extended time period; and

a telemetry circuit that transmits the activity measurements stored during the extended time period to an external monitor for display.

2. The device of claim 1 wherein the processor determines activity variance measurements.

3. The device of claim 1 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory a maximum activity variance measurement for each of the time intervals.

4. The device of claim 1 wherein the extended time period encompasses a plurality of time intervals and wherein the processor, periodically during each time interval, determines short-term activity measurements and corresponding long-term activity measurements and, during each time interval, stores in the memory a maximum active time, the maximum active time being a longest continuous time in which short-term activity measurements are greater than their corresponding long-term activity measurements.

5. The device of claim 1 wherein the extended time period encompasses a plurality of time periods and wherein the processor maintains a histogram of the activity measurements made during each time period, determines at least one histogram value for each time period, and stores the histogram values in the memory.

6. The device of claim 5 wherein the at least one histogram value corresponds to a maximum activity.

7. The device of claim 5 wherein the at least one histogram value corresponds to a mode activity variance.

8. The device of claim 5 wherein the at least one histogram value corresponds to a median activity variance.

9. The device of claim 1 further including a heart rate monitor, wherein the extended time period encompasses a plurality of time intervals, and wherein the processor stores in the memory after each time interval an average heart rate of the patient for when the patient is at rest.

10. The device of claim 9 wherein the average heart rate is an average atrial rate.

11. The device of claim 1 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory after each time interval a number of exercise episodes of the patient occurring during the time interval.

12. The device of claim 11 wherein each exercise episode is a continuous period of time longer than a preset time in which the activity measurements are above a given threshold.

13. The device of claim 11 wherein the processor further stores in the memory the cumulative time of the exercise episodes.

14. An implantable cardiac device that monitors, during an extended time period, a progression or regression in congestive heart failure of a patient comprising:

a respiration sensor that generates raw sensor signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression or regression of congestive heart failure;

a processor coupled to the respiration sensor that processes the raw signals to determine respiration measurements;

a memory coupled to the processor that stores the respiration measurements during the extended time period; and

a telemetry circuit that transmits the respiration measurements stored during the extended time period to an external monitor for display.

15. The device of claim 14 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory a maximum respiration measurement for each of the time intervals.

16. The device of claim 14 wherein the extended time period encompasses a plurality of time periods and wherein the processor, periodically, during each time period, determines a short-term minute volume measurement, a corresponding long-term minute volume measurement and a delta minute volume measurement based upon the difference between a short-term minute volume measurement and its corresponding long-term minute volume measurement.

17. The device of claim 16 wherein the processor maintains a histogram of the delta minute volume measurements made during each time period, determines at least one histogram value for each time period, and stores the histogram values in the memory.

18. The device of claim 14 wherein the respiration measurements include tidal volume, minute volume, and respiration rate.

19. The device of claim 14 further including an activity sensor that senses activity of the patient and wherein the processor determines the respiration measurements when the patient is in at least one given activity state.

20. The device of claim 19 wherein the processor determines the respiration measurements when the patient is in an exercise state.

21. The device of claim 20 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory exercise state respiration measurements for each of the time intervals.

22. The device of claim 21 wherein the respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

23. The device of claim 20 wherein the extended time interval encompasses a plurality of time intervals, wherein the processor determines the respirations measurements for each one of patient exercise episodes occurring during each time interval and stores in the memory the respiration measurements corresponding to a given one of the exercise episodes for each time interval.

24. The device of claim 23 wherein the respiration measurements include minute volume, and wherein the given one of the exercise episodes is the exercise episode yielding a greatest maximum minute volume.

25. The device of claim 24 wherein the stored respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

26. The device of claim 25 wherein the processor further stores a duration of the given exercise episode and a time stamp of the given exercise episode.

27. The device of claim 19 wherein the processor determines the respiration measurements when the patient is in a prolonged rest state.

28. The device of claim 27 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory average prolonged rest state respiration measurements for each time interval.

29. The device of claim 28 wherein the average respiration measurements include tidal volume, respiration rate, and minute volume.

30. The device of claim 29 wherein the processor determines the respiration measurements when the activity sensor and the respiration sensor indicate the patient is at rest and undergoing periodic breathing.

31. The device of claim 30 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory maximum respiration measurements for each time interval.

32. The device of claim 31 wherein the respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

33. The device of claim 32 wherein the stored maximum respiration rate and maximum tidal volume correspond in time to the maximum minute volume.

34. The device of claim 30 further including a counter and wherein the processor further increments the counter at periodic intervals when the patient is at rest and undergoing periodic breathing.

35. The device of claim 34 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory a total count for each time interval.

36. The device of claim 30 further including a timer and wherein the processor further increments the timer at periodic intervals when the patient is at rest and undergoing periodic breathing.

37. The device of claim 36 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory a total timer duration for each time interval.

38. The device of claim 19 wherein the processor determines minute volume measurements when the patient is at rest and determines the presence of cycling breathing when the minute volume is less than a given threshold.

39. The device of claim 38 wherein the processor determines at least one respiration of measurement of hyperventilation period, hypoventilation period, single cycle breathing period, cycles per cycling breathing episode and total time of cycling breathing.

40. The device of claim 39 wherein the extended time period encompasses a plurality of time intervals and wherein the processor stores in the memory the at least one respiration measurement for each time interval.

41. An implantable cardiac device that monitors a progression or regression in congestive heart failure of a patient during an extended time period, comprising:

an activity sensor that generates raw sensor signals indicative of the patient'"'"'s activity level, wherein a degradation or improvement of the patient'"'"'s activity level over time corresponds to an indication of the progression or regression of congestive heart failure;

a respiration sensor that generates raw sensor signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression or regression of congestive heart failure;

a processor coupled to the activity sensor that processes the raw signals to determine activity and minute volume measurements;

a memory coupled to the processor that stores the activity and minute volume measurements during the extended time period; and

a telemetry circuit that transmits the activity and minute volume measurements stored during the extended time period to an external monitor for display.

42. The device of claim 41 wherein the processor determines delta minute volume measurements based upon the minute volume measurements, creates histograms of the activity and delta minute volume measurements and at spaced apart times derives histogram values from the histograms.

43. The device of claim 42 wherein the processor stores the histogram values in the memory.

44. An implantable cardiac device that provides historical physiological parameter measurements indicative of a progression or regression in congestive heart failure of a patient comprising:

activity sensing means for generating raw sensor signals indicative of the patient'"'"'s activity level, wherein a degradation or improvement of the patient'"'"'s activity level over time corresponds to an indication of the progression or regression of congestive heart failure;

processing means for processing the raw signals to determine activity measurements;

storage means for storing the activity measurements during an extended time period; and

telemetry means for transmitting the stored activity measurements to an external monitor for display.

45. The device of claim 44 wherein the processing means includes means for determining activity variance measurements.

46. The device of claim 44 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the memory a maximum activity variance measurement for each of the time intervals.

47. The device of claim 44 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for periodically, during each time interval, determining short-term activity measurements and corresponding long-term activity measurements and, during each time interval, storing in the storage means a maximum active time, the maximum active time being a longest continuous time in which short-term activity measurements are longer than the corresponding long-term activity measurements.

48. The device of claim 44 wherein the extended time period encompasses a plurality of time periods and wherein the processing means includes means for maintaining a histogram of the activity measurements made during each time period, means for determining at least one histogram of the activity measurements made during each time period, means for determining at least one histogram value for each time period, and means for storing the histogram values in the storage means.

49. The device of claim 48 wherein the at least one histogram value corresponds to a maximum activity.

50. The device of claim 48 wherein the at least one histogram value corresponds to a mode activity variance.

51. The device of claim 48 wherein the at least one histogram value corresponds to a median activity variance.

52. The device of claim 44 further including means for monitoring heart rate, wherein the extended time period encompasses a plurality of time intervals, and wherein the processing means includes means for storing in the storage means after each time interval an average heart rate of the patient for when the patient is at rest.

53. The device of claim 52 wherein the average heart rate is an average atrial rate.

54. The device of claim 44 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the storage means after each time intervals a number of exercise episodes of the patient occurring during the time interval.

55. The device of claim 54 wherein each exercise episode is a continuous period of time longer than a preset time in which the activity measurements are above a given threshold.

56. The device of claim 54 wherein the processor further includes means for storing in the storage means the cumulative time of the exercise episodes.

57. An implantable cardiac device that provides historical physiological parameter measurements indicative of a progression or regression in congestive heart failure of a patient comprising:

respiration sensing means for generating sensor signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression or regression of congestive heart failure;

processing means for processing the raw signals to determine respiration measurements;

storage means for storing the respiration measurements during an extended time period; and

telemetry means for transmitting the stored respiration measurements to an external monitor for display.

58. The device of claim 57 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the storage mans a maximum minute volume measurement for each of the time intervals.

59. The device of claim 57 wherein the extended time period encompasses a plurality of time periods and wherein the processing means includes means for periodically, during each time period, determining a short-term minute volume measurement, a corresponding long-term minute volume measurement, and a delta minute volume measurement based upon the difference between a short-term minute volume measurement and its corresponding long-term minute volume measurement.

60. The device of claim 59 wherein the processing means includes means for maintaining a histogram of the delta minute volume measurements made during each time interval, means for determining at least one histogram value for each time period, and means for storing the histogram values in the storage means.

61. The device of claim 57 wherein the respiration measurements include tidal volume, minute volume and respiration rate.

62. The device of claim 57 further including activity sensing means for sensing activity of the patient and wherein the processing means determines the respiration measurements when the patient is in at least one given activity state.

63. The device of claim 62 wherein the processing means determines the respiration measurements when the patient is in an exercise state.

64. The device of claim 63 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the storage means exercise state respiration measurements for each of the time intervals.

65. The device of claim 64 wherein the respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

66. The device of claim 63 wherein the extended time interval encompassed a plurality of time intervals, wherein the processing means determines the respirations measurements for each one of patient exercise episodes occurring during each time interval and includes means for storing in the storage means the respiration measurements corresponding to a given one of the exercise episodes for each time interval.

67. The device of claim 66 wherein the respiration measurements include minute volume, and wherein the given one of the exercise episodes is the exercise episode yielding a greatest maximum minute volume.

68. The device of claim 67 wherein the stored respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

69. The device of claim 68 wherein the processing means further includes means for storing a duration of the given exercise episode and a time stamp of the given exercise episode.

70. The device of claim 62 wherein the processing means determines the respiration measurements when the patient is in a prolonged rest state.

71. The device of claim 70 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the storage means average prolonged rest state respiration measurements for each time interval.

72. The device of claim 71 wherein the average respiration measurements include tidal volume, respiration rate, and minute volume.

73. The device of claim 62 wherein the processing means determines the respiration measurements when the activity sensing means and the respiration sensing means indicate the patient is at rest and undergoing periodic breathing.

74. The device of claim 73 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the storage mans maximum respiration measurements for each time interval.

75. The device of claim 74 wherein the respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

76. The device of claim 75 wherein the stored maximum respiration rate and maximum tidal volume correspond in time to the maximum minute volume.

77. The device of claim 73 further including means for counting and wherein the processing means further includes means for incrementing the means for counting at periodic intervals when the patient is at rest and undergoing periodic breathing.

78. The device of claim 77 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the storage means a total count for each time interval.

79. The device of claim 73 further including means for timing and wherein the processor further includes means for incrementing the means for timing at periodic intervals when the patient is at rest and undergoing periodic breathing.

80. The device of claim 79 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the storage means a total duration of the means for timing for each time interval.

81. The device of claim 62 wherein the processing means includes means for determining minute volume measurements when the patient is at rest and the presence of cycling breathing when the minute volume is less than a given threshold.

82. The device of claim 81 wherein the processing means determines at least one respiration of measurement of hyperventilation period, hypoventilation period, single cycle breathing period, cycles per cycling breathing episode and total time of cycling breathing.

83. The device of claim 82 wherein the extended time period encompasses a plurality of time intervals and wherein the processing means includes means for storing in the storage means the at least respiration measurement for each time interval.

84. An implantable cardiac device that provides historical physiological parameter measurements indicative of a progression or regression in congestive heart failure condition of a patient comprising:

activity sensing means for generating raw sensor signals indicative of the patient'"'"'s activity level, wherein a degradation or improvement of the patient'"'"'s activity level over time corresponds to an indication of the progression or regression of congestive heart failure;

respiratory sensing means for generating raw sensor signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression or regression of congestive heart failure;

processing means for processing the raw signals to determine activity and respiration volume measurements;

storage means for storing the activity and respiration measurements during an extended time period; and

telemetry means for transmitting the stored activity and respiration measurements to an external monitor for display.

85. The device of claim 84 wherein the processing means includes means for determining delta minute volume measurements based upon the minute volume measurements, means for creating histograms of the activity and delta minute volume measurements, and means for deriving histogram values from the histogram at spaced apart times.

86. The device of claim 84 wherein the processing means includes means for storing the histogram values in the storage means.

87. In an implantable cardiac device, a method of providing historical physiological parameter measurements indicative of a progression or regression in a patient'"'"'s congestive heart failure condition, the method including the steps of:

generating raw signals indicative of the patient'"'"'s activity level, wherein a degradation or improvement of the patient'"'"'s activity level over time corresponds to an indication of the progression or regression of congestive heart failure;

processing the raw signals to determine activity measurements;

storing the activity measurements during an extended time period; and

transmitting the stored activity measurements to an external monitor for display.

88. The method of claim 87 wherein the processing step includes determining activity variance measurements.

89. The method of claim 87 wherein the extended time period encompasses a plurality of time intervals and wherein the processing step includes determining a maximum activity variance measurement for each of the time intervals.

90. The method of claim 87 wherein the time period encompasses a plurality of time intervals and wherein the processing step includes periodically, during each time interval, determining short-term activity measurements and corresponding long-term activity measurements and, during each time interval, storing in the memory a maximum active time, the maximum active time being a longest continuous time in which short-term activity measurements are greater than the corresponding long-term activity measurements.

91. The method of claim 87 wherein the extended time period encompasses a plurality of time periods and wherein the processing step includes maintaining a histogram of the activity measurements made during each time period and determining at least one histogram value for each time period.

92. The method of claim 91 wherein the at least one histogram value corresponds to maximum activity of the patient.

93. The method of claim 91 wherein the maintaining step includes the step of maintaining a histogram of activity variance measurements.

94. The method of claim 93 wherein the determining step includes determining a histogram value corresponding to mode activity variance.

95. The method of claim 93 wherein the determining step includes determining a histogram value corresponding to median activity variance.

96. The method of claim 87 wherein the extended time period encompasses a plurality of time intervals and wherein the method further includes the steps of monitoring heart rate of the patient and storing, for each time interval, an average heart rate of the patient for when the patient is at rest.

97. The method of claim 96 wherein the average heart rate is an average atrial rate.

98. The method of claim 87 wherein the extended time period encompasses a plurality of time intervals and method further includes the steps of determining exercise episodes of the patient and storing, for each time interval, a number of exercise episodes of the patient.

99. The method of claim 98 including the further step of counting an exercise episode when a continuous period of time longer than a preset time elapses in which the activity measurements are above a given threshold.

100. The method of claim 98 including the further step of storing a cumulative time of the exercise episodes.

101. In an implantable cardiac device, a method of providing historical physiological parameter measurements indicative of a progression or regression in a patient'"'"'s congestive heart failure, the method including the steps of:

generating raw signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression or regression of congestive heart failure;

processing the raw signals to determine respiration measurements;

storing the respiration measurements during an extended time period; and

transmitting the stored respiration measurements to an external monitor for display.

102. The method of claim 101 wherein the extended time period encompasses a plurality of time intervals and wherein the processing step includes determining a maximum minute volume measurement for each of the time intervals.

103. The method of claim 101 wherein the extended time period encompasses a plurality of time periods and wherein the processing step includes periodically, during each time period, determining a short-term minute volume measurement, a corresponding long-term minute volume measurement, and a delta minute volume measurement based upon the difference between a short-term minute volume measurement and its corresponding long-term minute volume measurement.

104. The method of claim 103 wherein the processing step includes maintaining a histogram of the delta minute volume measurements made during each time period and determining at least one histogram value for each time period.

105. The method of claim 101 wherein the respiration measurements include tidal volume, minute volume and respiration rate.

106. The method of claim 101 further including the step of sensing activity of the patient and wherein the respiration measurements are determined when the patient is in at least one given activity state.

107. The method of claim 106 wherein the respiration measurements are determined when the patient is in an exercise state.

108. The method of claim 107 wherein the extended time period encompasses a plurality of time intervals and wherein the storing step includes storing the respiration measurements for each of the time intervals.

109. The method of claim 108 wherein the respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

110. The method of claim 107 wherein the extended time period encompasses a plurality of time intervals and wherein the method further includes the steps of determining exercise episodes of the patient, determining the respiration measurements for each exercise episode, and storing the respiration measurements corresponding to a given one of the exercise episodes for each time interval.

111. The method of claim 110 wherein the respiration measurements include minute volume, and wherein the given one of the exercise episodes is the exercise episode yielding a greatest maximum minute volume.

112. The method of claim 111 wherein the stored respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

113. The method of claim 112 including the further step of storing duration of the given exercise episode and a time stamp corresponding to the given exercise episode.

114. The method of claim 106 including the further step of determining prolonged rest states of the patient and wherein the respiration measurements are determined when the patient is in a prolonged rest state.

115. The method of claim 114 wherein the extended time period encompasses a plurality of time intervals and wherein the storing step includes storing average prolonged rest state respiration measurements for each time interval.

116. The method of claim 115 wherein the averaged respiration measurements include tidal volume, respiration rate, and minute volume.

117. The method of claim 106 including the further step of determining when the patient is at rest and undergoing periodic breathing.

118. The method of claim 117 wherein the extended time period encompasses a plurality of time intervals and wherein the method further includes the step of storing maximum respiration measurements for each time interval for when the patient is at rest and undergoing periodic breathing.

119. The method of claim 118 wherein the respiration measurements include maximum respiration rate, maximum tidal volume, and maximum minute volume.

120. The method of claim 119 wherein the stored maximum respiration rate and maximum tidal volume correspond in time to the maximum minute volume.

121. The method of claim 117 including the further step of counting at periodic intervals when the patient is at rest and undergoing periodic breathing.

122. The method of claim 121 wherein the extended time period encompasses a plurality of time intervals and wherein the method includes the further steps of providing and storing a total count for each time interval.

123. The method of claim 117 including the further step of timing when the patient is at rest and undergoing periodic breathing.

124. The method of claim 123 wherein the extended time period encompasses a plurality of time intervals and wherein the method further includes the steps of providing and storing a total time duration for each time interval for when the patient is at rest and undergoing periodic breathing.

125. The device of claim 106 including the further steps of determining minute volume measurements when the patient is at rest and determining the presence of cycling breathing when the minute volume is less than a given threshold.

126. The method of claim 125 wherein the processing step includes determining at least one respiration of measurement of hyperventilation period, hypoventilation period, single cycle breathing period, cycles per cycling breathing episode and total time of cycling breathing.

127. The method of claim 126 wherein the extended time period encompasses a plurality of time intervals and wherein the storing step includes storing the at least one respiration measurement for each time interval.

128. In an implantable cardiac device a method of providing historical physiological parameter measurements indicative of progression or regression in a patient'"'"'s congestive heart failure condition including the steps of:

generating raw signals indicative of the patient'"'"'s activity level, wherein a degradation of the patient'"'"'s activity level over time corresponds to an indication of the progression or regression of congestive heart failure;

generating raw signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression or regression of congestive heart failure;

processing the raw signals to determine activity and respiration measurements;

storing the activity and respiration measurements during an extended time period; and

transmitting the stored activity and respiration measurements to an external monitor for display.

129. The method of claim 128 wherein the processing step includes determining delta minute volume measurements based upon the minute volume measurements, creating histograms of the activity and delta minute volume measurements and deriving histogram values from the histograms at spaced apart times.

130. An implantable pacemaker that provides pacing therapy to a heart and monitors, during an extended time period, a progression or regression in congestive heart failure comprising:

a pacer that provides pacing therapy to the heart;

a respiration sensor that generates raw sensor signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression or regression of congestive heart failure;

a processor coupled to the respiration sensor that processes the raw signals to determine respiration measurements and controls the pacer;

a memory coupled to the processor that stores the respiration measurements during the extended time period;

a telemetry circuit that transmits the respiration measurements stored during the extended time period to an external monitor for display; and

the processor being programmed to adjust the pacing therapy provided by the pacer responsive to the respiration measurements.

131. The pacemaker of claim 130 wherein the processor is programmed to adjust pacing rate.

132. The pacemaker of claim 130 further including an activity sensor that senses activity of the patient, and wherein the processor stores the respiration measurements when the patient is in at least one active state.

133. An implantable pacemaker for providing pacing therapy to a heart and historical physiological parameter measurements indicative of a progression or regression in congestive heart failure of a patient comprising:

pacing means for pacing the heart;

respiration sensing means for generating sensor signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression of congestive heart failure;

processing means for controlling the pacing means and for processing the raw signals to determine respiration measurements;

storage means for storing the respiration measurements during an extended time period;

telemetry means for transmitting the stored minute volume measurements to an external monitor for display; and

the processing means being responsive to the respiration measurements for controlling the pacing means.

134. The pacemaker of claim 133 wherein the processing means controls pacing rate of the pacing means.

135. The pacemaker of claim 133 further including activity sensing means for sensing activity of the patient, and wherein the processing means determines the respiration measurements when the patient is in at least one active state.

136. In an implantable pacemaker, a method of pacing a heart and providing historical physiological parameter measurements indicative of a progression or regression in a patient'"'"'s congestive heart failure, the method including the steps of:

pacing the heart to provide pacing therapy;

generating raw signals indicative of the patient'"'"'s respiration, wherein a degradation or improvement of the patient'"'"'s respiration level over time corresponds to an indication of the progression or regression of congestive heart failure;

processing the raw signals to determine respiration measurements;

storing the respiration measurements during an extended time period;

transmitting the stored respiration measurements to an external monitor for display; and

adjusting the pacing therapy responsive to the respiration measurements.

137. The method of claim 136 wherein the extended time period encompasses a plurality of time intervals and wherein the pacing therapy is adjusted during each of the time intervals.

138. The method of claim 136 wherein the adjusting step includes adjusting pacing rate.

139. The method of claim 136 including the further step of sensing activity of the patient, and wherein the processing step is performed when the patient is in at least one active state.