System and method for diagnosing and monitoring congestive heart failure for automated remote patient care

• US 6,908,437 B2
• Filed: 08/22/2003
• Issued: 06/21/2005
• Est. Priority Date: 11/16/1999
• Status: Expired due to Term

• Current Assignee: Cardiac Intelligence Corp (Boston Scientific Corporation)
• Original Assignee: Cardiac Intelligence Corp (Boston Scientific Corporation)
• Inventors: Bardy, Gust H.
• Primary Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US10/646,105
• Publication Number:
  US 20040147982A1
• Time in Patent Office: 669 Days
• Field of Search: 600/508, 600/509, 600/513, 600/300, 600/301, 128/920, 128/923, 607/4, 607/5, 607/9
• US Class Current: 600/508
• CPC Class Codes: A61B 2505/03 Intensive care
• CPC Class Codes: A61B 2560/0242 adapted to measure environmental factors, e.g. temperature, pollution
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/0004 characterised by the type of physiological signal transmitted
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• 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: A61B 5/02055 Simultaneously evaluating both cardiovascular condition and temperature
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/0245 by using sensing means generating electric signals, i.e. ECG signals
• CPC Class Codes: A61B 5/076 Permanent implantations telemetry using implanted circuitry A61B5/0031; implanted stimulators for therapy A61N1/3605, A61N1/362, A61N1/372
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/11 Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb for measuring pulse A61B5/02 ;A61B5/1038 takes precedence; motion detection to correct for motion artifacts in physiological signals A61B5/721
• CPC Class Codes: A61B 5/1112 Global tracking of patients, e.g. by using GPS
• CPC Class Codes: A61B 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/14546 for measuring analytes not otherwise provided for, e.g. ions, cytochromes
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• 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 5/486 : Bio-feedback A61B5/375 takes precedence
• CPC Class Codes: A61B 5/686 : Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7275 : Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61B 5/7278 : Artificial waveform generation or derivation, e.g. synthesising signals from measured signals A61B5/327 takes precedence
• CPC Class Codes: A61B 5/7282 : Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• 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 40/67 : for remote operation
• CPC Class Codes: G16H 50/30 : for calculating health indices; for individual health risk assessment
• CPC Class Codes: Y10S 128/923 : by comparison of patient data to other data

Abstract

A system for diagnosing and monitoring congestive heart failure for automated remote patient care is presented. A database stores a plurality of monitoring sets relating to patient information recorded on a substantially continuous basis. A server retrieving and processing the monitoring sets includes a comparison module determining patient status changes by comparing at least one recorded measure from one of the monitoring sets to at least one other recorded measure from another of the monitoring sets with both recorded measures relating to a type of patient information and an analysis module testing each patient status change for one of an onset, a progression, a regression, and a status quo of congestive heart failure against a predetermined indicator threshold corresponding to a type of patient information as the recorded measures. The indicator threshold corresponds to a quantifiable physiological measure of a pathophysiology indicative of congestive heart failure.

Claims

1. A system for diagnosing and monitoring congestive heart failure for automated remote patient care, comprising:

a database storing a plurality of monitoring sets which each comprise recorded measures relating to patient information recorded on a substantially continuous basis;

a server retrieving and processing a plurality of the monitoring sets, comprising;

a comparison module determining at least one patient status change by comparing at least one recorded measure from one of the monitoring sets to at least one other recorded measure from another of the monitoring sets with both recorded measures relating to a type of patient information; and

an analysis module testing each patient status change for one of an onset, a progression, a regression, and a status quo of congestive heart failure against a predetermined indicator threshold corresponding to a type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of congestive heart failure.

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

an analysis submodule managing the congestive heart failure through a means of performing at least one of preload reduction, afterload reduction, diuresis, beta-blockade, inotropic agents, electrolyte management, electrical therapies, and mechanical therapies.

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

one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient for recording device measures, and a medical device database module periodically receiving a monitoring set for an individual patient each recorded measure in the medical device monitoring set having been, recorded by the one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded and storing the received monitoring set in the database as part of a patent care record for the individual patient.

4. A system according to claim 3, further comprising:

a set of at least one further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than congestive heart failure;

a comparison submodule comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure; and

an analysis submodule testing each patient status change against each such further indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

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

a comparison submodule determining a change in patient status by comparing at least one quality of life measure stored in one of the monitoring sets to at least one other corresponding quality of life measure stored in another of the monitoring sets.

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

a set of at least one stickiness indicators for each type of patient information, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;

a comparison submodule comparing a time span occurring between each patient status change for each recorded measure to the stickiness indicator relating to the same type of patient information as the recorded measure being compared; and

an analysis submodule determining a revised program of patient diagnosis or treatment responsive to each patient status change occurring subsequent to a time span exceeding the stickiness indicator.

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

a database module retrieving the plurality of monitoring sets from one of a patient care record for an individual patient, a peer group, and a overall patient population.

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

the database further storing a reference baseline comprising recorded measures which each relate to patient information recorded during an initial time period and comprise either medical device measures or derived measures calculable therefrom; and

a database module obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

9. A system according to claim 1, wherein the indicator threshold relates to at least one of a finding of reduced exercise capacity and respiratory distress.

10. A system according to claim 9, wherein the indicator threshold relating to the finding of reduced exercise capacity is selected from the group comprising decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.

11. A system according to claim 9, wherein the indicator threshold relating to the finding of respiratory distress is selected from the group comprising increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.

12. A method for diagnosing and monitoring congestive heart failure for automated remote patient care, comprising:

storing a plurality of monitoring sets which each comprise recorded measures relating to patient information recorded on a substantially continuous basis in a database;

retrieving a plurality of the monitoring sets from the database;

determining at least one patient status change by comparing at least one recorded measure from one of the monitoring acts to at least one other recorded measure from another of the monitoring sets with both recorded measures relating to a type of patient information; and

testing each patient status change for one of an onset, a progression, a regression, and a status quo of congestive heart failure against a predetermined indicator threshold corresponding to a type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of congestive heart failure.

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

managing the congestive heart failure through administration of at least one of preload reduction, afterload reduction, diuresis, beta-blockade, inotropic agents, electrolyte management, electrical therapies, and mechanical therapies.

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

periodically receiving a monitoring set for an individual patient, each recorded measure in the monitoring set having been recorded by one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded; and

storing the received monitoring set in the database as part of a patient care record for the individual patient.

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

defining a set of further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than congestive heart failure;

comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure; and

testing each patient status change against each such further indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

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

determining a change in patient status by comparing at least one quality of life measure stored in one of the monitoring sets to at least one other corresponding quality of life measure stored in another of the monitoring sets.

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

defining a set of stickiness indicators for each type of patient information, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;

comparing a time span occurring between each patient status change for each recorded measure to the stickiness indicator relating to the same type of patient information as the recorded measure being compared; and

determining a revised program of patient diagnosis or treatment responsive to each patient status change occurring subsequent to a time span exceeding the stickiness indicator.

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

retrieving the plurality of monitoring sets from one of a patient care record for an individual patient, a peer group, and a overall patient population.

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

retrieving a reference baseline comprising recorded measures which each relate to patient information recorded during an initial time period and comprise either medical device measures or derived measures calculable therefrom; and

obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

20. A method according to claim 12, wherein the indicator threshold relates to at least one of a finding of reduced exercise capacity and respiratory distress.

21. A method according to claim 20, wherein the indicator threshold relating to the finding of reduced exercise capacity is selected from the group consisting of decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.

22. A method according to claim 20, wherein the indicator threshold relating to the finding of respiratory distress is selected from the group consisting of increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.

23. A computer-readable storage medium having code for diagnosing and monitoring congestive heart failure for automated remote patient care, the code comprising:

code for storing a plurality of monitoring sets which each comprise recorded measures relating to patient information recorded on a substantially continuous basis in a database;

code for operatively retrieving a plurality of monitoring sets from the database;

code for operatively determining at least one patient status change by comparing at least one recorded measure from one of the monitoring sets to at least one other recorded measure from another of the monitoring sets with both recorded measures relating to a type of patient information; and

code for operatively testing each patient status change for one of an onset, a progression, a regression, and a status quo of congestive heart failure against a predetermined indicator threshold corresponding to a type of patient information as the recorded measures which were compared, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of congestive heart failure.

24. A storage medium according to claim 23, further comprising:

code for operatively managing the congestive heart failure through administration of at least one of preload reduction, afterload reduction, diuresis, beta-blockade, inotropic agents, electrolyte management, electrical therapies, and mechanical therapies.

25. A storage medium according to claim 23, further comprising:

code for operatively periodically receiving a monitoring set for an individual patient, each recorded measure in the monitoring set having been recorded by one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded; and

code for operatively storing the received monitoring set in the database as part of a patient care record for the individual patient.

26. A storage medium according to claim 25, further comprising:

defining a set of at least one further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than congestive heart failure;

comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure; and

testing each patient status change against each such further indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

27. A storage medium according to claim 23, further comprising:

code for operatively determining a change in patient status by comparing at least one quality of life measure stored in one of the monitoring set to at least one other corresponding quality of life measure stored in another of the monitoring sets.

28. A storage medium according to claim 23, further comprising:

code for operatively defining a set of stickiness indicators for each type of patient information, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;

code for operatively comparing a time span occurring between each patient status change for each recorded measure to the stickiness indicator relating to the same type of patient information as the recorded measure being compared; and

code for operatively determining a revised program of patient diagnosis or treatment responsive to each patient status change occurring subsequent to a time span exceeding the stickiness indicator.

29. A storage medium according to claim 23, further comprising:

code for operatively retrieving the plurality of monitoring sets from one of a patient care record for an individual patient, a peer group, and a overall patient population.

30. A storage medium according to claim 23, further comprising:

code for operatively retrieving a reference baseline comprising recorded measures which each relate to patient information recorded during an initial time period and comprise either medical device measures or derived measures calculable therefrom; and

code for operatively obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

31. An automated collection and analysis patient care system for diagnosing and monitoring congestive heart failure for remote patient care, comprising:

a database storing patient monitoring information, comprising;

a plurality of monitoring sets, each monitoring set comprising recorded measures which each relate to patient information and comprise either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;

a set of at least one stored indicator threshold, each indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of congestive heart failure and relating to a type of patient information as at least one of the recorded measures; and

a server diagnosing a congestive heart failure finding comprising one of an onset, a progression, a regression and a status quo of congestive heart failure, comprising;

an analysis module determining a change in patient status by comparing at least one recorded measure to at least one other recorded measure with both recorded measures relating to a type of patient information; and

a comparison module comparing each patient status change to the indicator threshold corresponding to a type of patient information as the recorded measures which were compared.

32. A system according to claim 31, wherein the device measures are recorded by a medical device that is one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures arc recorded.

33. A system according to claim 31, wherein each of the monitoring sets comprises recorded measures relating to patient information solely for the individual patient, further comprising:

a database module retrieving each monitoring set from a patient care record for an individual patient and obtaining the at least one recorded measure and the at least one other recorded measure from the retrieved monitoring sets.

34. A system according to claim 31, wherein each of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, further comprising:

a database module retrieving at least one monitoring set from a patient care record for the individual patient, retrieving at least one other monitoring set from a patient care record in the same patient peer group, and obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

35. A system according to claim 31, wherein each of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, further comprising:

a database module retrieving at least one monitoring set from a patient care record for the individual patient, retrieving at least one other monitoring set from a patient care record in the overall patient population, and obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

36. A system according to claim 31, further comprising:

the reference baseline database storing a reference baseline comprising recorded measures which each relate to patient information recorded by the medical device adapted to be implanted during an initial time period and comprise either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and

a database module obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

37. A system according to claim 36, wherein the reference baseline comprises recorded measures relating to patient information for one of the individual patients solely, a peer group of patients to which the individual patient belongs, and a general population of patients.

38. A system according to claim 31, wherein the set of stored indicator thresholds relate to reduced exercise capacity selected from the primary group consisting of decreased cardiac output, the secondary group consisting of decreased mixed venous oxygen score and decreased patient activity score, and the tertiary group consisting of increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.

39. A system according to claim 31, wherein the set of stored indicator thresholds relate to respiratory distress selected from the primary group consisting of increased pulmonary artery diastolic pressure, the secondary group consisting of increased respiratory rate and decreased transthoracic impedance, and the tertiary group consisting of decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.

40. A system according to claim 31, further comprising:

a comparison submodule grading the comparisons between each patient status change and corresponding indicator threshold on a fixed scale based on a degree of deviation from the indicator threshold and determining an overall patient status change by performing a summation over the individual graded comparisons.

41. A system according to claim 31, further comprising:

a comparison submodule determining probabilistic weightings of the comparisons between each patient status change and corresponding indicator threshold based on a statistical deviation and trends via linear fits from the indicator threshold and determining an overall patient status change by performing a summation over the individual graded comparisons.

42. A system according to claim 31, wherein each monitoring set further comprises quality of life and symptom measures recorded by the individual patient, the server further comprising:

a quality of life module determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure; and

the server incorporating each patient status change in quality of life into the congestive heart failure finding to either refute or support the diagnosis.

43. A system according to claim 31, further comprising:

a set of at least one stored further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than congestive heart failure of disease; and

the server diagnosing a finding of a disease other than congestive heart failure, the comparison module further comprising comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure.

44. A system according to claim 31, further comprising:

a timer measuring a time span occurring between each patient status change for each recorded measure;

a set of at least one stickiness indicators, each indicator threshold corresponding to a temporal limit related to a course of patient care; and

a feedback module comparing a time span between each patient status change for each recorded measure to the stickiness indicator corresponding to the same type of patient information as the recorded measure being compared.

45. A system according to claim 31, further comprising:

a feedback module providing automated feedback to an individual patient when a congestive heart failure finding is indicated.

46. A system according to claim 45, further comprising:

the feedback module performing an interactive dialogue between the individual patient and the patient care system regarding a medical condition of the individual patient.

47. A method for diagnosing and monitoring congestive heart failure using an automated collection and analysis patient care system, comprising:

storing a plurality of monitoring sets in a database, each monitoring set comprising recorded measures which each relate to patient information and comprise either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;

retrieving a plurality of monitoring sets from the database;

defining a set of at least one stored indicator threshold, each indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of congestive heart failure and relating to a type of patient information as at least one of the recorded measures; and

diagnosing a congestive heart failure finding comprising one of an onset, a progression, a regression, and a status quo of congestive heart failure, comprising;

determining a change in patient status by comparing at least one recorded measure to at least one other recorded measure with both recorded measures relating to a type of patient information; and

comparing each patient status change to the indicator threshold corresponding to a type of patient information as the recorded measures which were compared.

48. A method according to claim 47, wherein the device measures are recorded by one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient when the device measures are recorded.

49. A method according to claim 48, wherein each of the monitoring sets comprises recorded measures relating to patient information solely for the individual patient, further comprising:

retrieving each monitoring set from a patient care record for an individual patient; and

obtaining the at least one recorded measure and the at least one other recorded measure from the retrieved monitoring sets.

50. A method according to claim 47, wherein each of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, further comprising:

retrieving at least one monitoring set from a patient care record for the individual patient;

retrieving at least one other monitoring set from a patient care record in the same patient peer group; and

obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

51. A method according to claim 47, wherein each of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, further comprising:

retrieving at least one monitoring set from a patient care record for the individual patient;

retrieving at least one other monitoring set from a patient care record in the overall patient population; and

obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

52. A method according to claim 47, further comprising:

retrieving a reference baseline comprising recorded measures which each relate to patient information recorded by the medical device adapted to be implanted during an initial time period and comprise either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and

obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

53. A method according to claim 52, wherein the reference baseline comprises recorded measures relating to patient information for one of the individual patients solely, a peer group of patients to which the individual patient belongs, and a general population of patients.

54. A method according to claim 47, wherein the set of stored indicator thresholds relate to reduced exercise capacity selected from the primary group consisting of decreased cardiac output, the secondary group consisting of decreased mixed venous oxygen score and decreased patient activity score, and the tertiary group consisting of increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.

55. A method according to claim 47, wherein the set of stored indicator thresholds relate to respiratory distress selected from the primary group consisting of increased pulmonary artery diastolic pressure, the secondary group consisting of increased respiratory rate and decreased transthoracic impedance, and the tertiary group consisting of decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.

56. A method according to claim 47, further comprising:

grading the comparisons between each patient status change and corresponding indicator threshold on a fixed scale based on a degree of deviation from the indicator threshold; and

determining an overall patient status change by performing a summation over the individual graded comparisons.

57. A method according to claim 47, further comprising:

determining probabilistic weightings of the comparisons between each patient status change and corresponding indicator threshold based on a statistical deviation and trends via linear fits from the indicator threshold; and

determining an overall patient status change by performing a summation over the individual graded comparisons.

58. A method according to claim 47, wherein each monitoring set further comprises quality of life and symptom measures recorded by an individual patient, the operation of diagnosing a congestive heart failure finding further comprising:

determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure; and

incorporating each patient status change in quality of life into the congestive heart failure finding to either refute or support the diagnosis.

59. A method according to claim 47, further comprising:

defining a set of further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than congestive heart failure; and

diagnosing a finding of the disease other than congestive heart failure, comprising comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure.

60. A method according to claim 47, further comprising:

defining a set of stickiness indicators, each indicator threshold corresponding to a temporal limit related to a course of patient care; and

comparing a time span between each patient status change for each recorded measure to the stickiness indicator corresponding to the same type of patient information as the recorded measure being compared.

61. A method according to claim 47, further comprising:

providing automated feedback to the individual patient when a congestive heart failure finding is indicated.

62. A method according to claim 61, further comprising:

performing an interactive dialogue between the individual patient and the patient care system regarding a medical condition of the individual patient.

63. A computer-readable storage medium having code for diagnosing and monitoring congestive heart failure using an automated collection and analysis patient care system, the code comprising:

code for storing a plurality of monitoring sets from a database, each monitoring set comprising recorded measures which each relate to patient information and comprise either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;

code for operatively retrieving a plurality of the monitoring sets from the database;

code for operatively defining a set of at least one indicator threshold, each indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology indicative of congestive heart failure and relating to the same type of patient information as at least one of the recorded measures; and

code for operatively diagnosing a congestive heart failure finding comprising one of an onset, a progression, a regression, and a status quo of congestive heart failure, comprising;

code for operatively determining a change in patient status by comparing at least one recorded measure to at least one other recorded measure with both recorded measures relating to the same type of patient information; and

code for operatively comparing each patient status change to the indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.

64. A storage medium according to claim 63, wherein each of the monitoring sets comprises recorded measures relating to patient information solely for the individual patient, further comprising:

code for operatively retrieving each monitoring set from a patient care record for the individual patient; and

code for operatively obtaining the at least one recorded measure and the at least one other recorded measure from the retrieved monitoring sets.

65. A storage medium according to claim 63, wherein each of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, further comprising:

code for operatively retrieving at least one monitoring set from a patient care record for the individual patient;

code for operatively retrieving at least one other monitoring set from a patient care record in the same patient peer group; and

code for operatively obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

66. A storage medium according to claim 63, wherein each of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, further comprising:

code for operatively retrieving at least one monitoring set from a patient care record for the individual patient;

code for operatively retrieving at least one other monitoring set from a patient care record in the overall patient population; and

code for operatively obtaining the at least one recorded measure from the at least one monitoring set and the at least one other recorded measure from the at least one other monitoring set.

67. A storage medium according to claim 63, further comprising:

code for operatively retrieving a reference baseline comprising recorded measures which each relate to patient information recorded by the medical device adapted to be implanted during an initial time period and comprise either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and

code for operatively obtaining at least one of the at least one recorded measure and the at least one other recorded measure from the retrieved reference baseline.

68. A storage medium according to claim 63, the operation of comparing each patient status change further comprising:

code for operatively grading the comparisons between each patient status change and corresponding indicator threshold on a fixed scale based on a degree of deviation from the indicator threshold; and

code for operatively determining an overall patient status change by performing a summation over the individual graded comparisons.

69. A storage medium according to claim 63, the operation of comparing each patient status change further comprising:

code for operatively determining probabilistic weightings of the comparisons between each patient status change and corresponding indicator threshold based on a statistical deviation and trends via linear fits from the indicator threshold; and

code for operatively determining an overall patient status change by performing a summation over the individual graded comparisons.

70. A storage medium according to claim 63, wherein each monitoring set further comprises quality of life and symptom measures recorded by the individual patient, the operation of diagnosing a congestive heart failure finding further comprising:

code for operatively determining a change in patient status by comparing at least one recorded quality of life measure to at least one other corresponding recorded quality of life measure; and

code for operatively incorporating each patient status change in quality of life into the congestive heart failure finding to either refute or support the diagnosis.

71. A storage medium according to claim 63, further comprising:

code for defining a set of at least one further indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than congestive heart failure; and

code for diagnosing a finding of the disease other than congestive heart failure, comprising comparing each patient status change to each such further indicator threshold corresponding to the same type of patient information as the at least one recorded measure and the at least one other recorded measure.

72. A storage medium according to claim 63, further comprising:

code for defining a set of at least one stickiness indicators, each indicator threshold corresponding to a temporal limit related to a course of patient care; and

code for comparing a time span between each patient status change for each recorded measure to the stickiness indicator corresponding to the same type of patient information as the recorded measure being compared.

73. A storage medium according to claim 63, further comprising:

code for operatively providing automated feedback to the individual patient when a congestive heart failure finding is indicated.

74. A storage medium according to claim 73, further comprising:

code for operatively performing an interactive dialogue between the individual patient and the patient care system regarding a medical condition of the individual patient.

75. An automated patient care system for diagnosing and monitoring congestive heart failure for remote patient care, comprising:

a medical device regularly recording measures relating to at least one of monitoring reduced exercise capacity and respiratory distress;

a database maintaining information for an individual patient, comprising organizing a plurality of monitoring sets in a database, and storing the recorded measures for the individual patient on a substantially continuous basis into a monitoring set in the database;

a server evaluating a finding of at least one of an onset, a progression, a regression, and a status quo of congestive heart failure, comprising;

a database module periodically retrieving a plurality of the monitoring sets from the database;

a comparison module determining at least one patient status change by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to a type of patient information; and

an analysis module testing each patient status change for congestive heart failure against predetermined indicator thresholds corresponding to a type of patient information as the recorded measures which were compared, the indicator thresholds corresponding to quantifiable physiological measures of pathophysiologies indicative of reduced exercise capacity and respiratory distress.

76. A system according to claim 75, wherein the indicator threshold relating to reduced exercise capacity is selected from the primary group consisting of decreased cardiac output, the secondary group consisting of decreased mixed venous oxygen score and decreased patient activity score, and the tertiary group consisting of increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.

77. A system according to claim 75, wherein the indicator threshold relating to respiratory distress is selected from the primary group consisting of increased pulmonary artery diastolic pressure, the secondary group consisting of increased respiratory rate and decreased transthoracic impedance, and the tertiary group consisting of decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.

78. A method for diagnosing and monitoring congestive heart failure in an automated patient care system, comprising:

regularly recording measures relating to at least one of monitoring reduced exercise capacity and respiratory distress;

maintaining information for an individual patient, comprising;

organizing a plurality of monitoring sets in a database;

storing the recorded measures for the individual patient on a substantially continuous basis into a monitoring set in the database;

periodically retrieving a plurality of the monitoring sets from the database;

evaluating a finding of at least one of an onset, a progression, a regression, and a status quo of congestive heart failure, comprising;

determining at least one patient status change by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to a type of patient information; and

testing each patient status change for congestive heart failure against predetermined indicator thresholds corresponding to a type of patient information as the recorded measures which were compared, the indicator thresholds corresponding to quantifiable physiological measures of pathophysiologies indicative of reduced exercise capacity and respiratory distress.

79. A method according to claim 78, wherein the indicator threshold relating to reduced exercise capacity is selected from the primary group consisting of decreased cardiac output, the secondary group consisting of decreased mixed venous oxygen score and decreased patient activity score, and the tertiary group consisting of increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.

80. A method according to claim 78, wherein the indicator threshold relating to respiratory distress is selected from the primary group consisting of increased pulmonary artery diastolic pressure, the secondary group consisting of increased respiratory rate and decreased transthoracic impedance, and the tertiary group consisting of decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.

81. A computer-readable storage medium having code for diagnosing and monitoring congestive heart failure in an automated patient care system, the code comprising:

code for regularly recording measures relating to at least one of monitoring reduced exercise capacity and respiratory distress;

code for maintaining information for an individual patient, comprising;

code for organizing a plurality of monitoring sets in a database;

code for storing the recorded measures for the individual patient on a substantially continuous basis into a monitoring set in the database;

code for periodically retrieving a plurality of the monitoring sets from the database;

code for evaluating a finding of at least one of an onset, a progression, a regression, and a status quo of congestive heart failure, comprising;

code for determining at least one patient status change by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure with both recorded measures relating to a type of patient information; and

code for testing each patient status change for congestive heart failure against predetermined indicator thresholds corresponding to a type of patient information as the recorded measures which were compared, the indicator thresholds corresponding to quantifiable physiological measures of pathophysiologies indicative of reduced exercise capacity and respiratory distress.