Remote closed-loop titration of decongestive therapy for the treatment of advanced heart failure
First Claim
1. An apparatus comprising:
- one or more physiological sensing circuits including an implantable sensing circuit and an external sensing circuit, wherein the implantable physiological sensing circuit is configured to provide a first sensed physiological signal and the external sensing circuit is configured to provide a second sensed physiological signal, wherein the second sensed physiological signal is representative of at least one of;
weight of the subject, respiration of the subject, a heart sound of the subject, arterial blood pressure of the subject, an indication of peripheral edema of the subject, thoracic fluid present in the subject, or a level of biochemical analyte present in the subject;
a measurement circuit configured to recurrently measure one or more physiological parameters of a subject that indicate a status of heart failure of the subject, including a first physiological parameter using the first sensed physiological signal and a second physiological parameter using the second sensed physiological signal, wherein the second physiological parameter includes at least one of a measured weight of the subject, a respiration parameter of the subject, a magnitude of a heart sound, a time interval between a first heart sound signal feature and a second heart sound signal feature, a measured arterial blood pressure of the subject, a measure of edema of the subject, or an indication of a level of biochemical analyte present in the subject;
a comparison circuit configured to compare the first physiological parameter to a target first physiological parameter value and the second physiological parameter to a target second physiological parameter value and provide an indication of an outcome of a comparison;
a therapy circuit configured to control delivery of one or more drugs to treat heart failure; and
a control circuit in electrical communication with the comparison circuit and the therapy circuit and configured to adjust delivery of the drug therapy according to the outcome of the comparison of the first and second physiological parameters to the target first and second physiological parameter values.
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Accused Products
Abstract
An apparatus comprises one or more physiological sensing circuits that generate a sensed physiological signal and at least one of the physiological sensing circuits is implantable, a measurement circuit configured to recurrently measure one or more physiological parameters that indicate a status of heart failure of the subject, a comparison circuit configured to compare the one or more physiological parameter measurements to one or more physiological parameter target values, a therapy circuit configured to control delivery of one or more drugs to treat heart failure, and a control circuit in electrical communication with the comparison circuit and the therapy circuit and configured to recurrently adjust delivery of drug therapy according to the comparison of the measured physiological parameters to the physiological parameter targets.
138 Citations
18 Claims
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1. An apparatus comprising:
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one or more physiological sensing circuits including an implantable sensing circuit and an external sensing circuit, wherein the implantable physiological sensing circuit is configured to provide a first sensed physiological signal and the external sensing circuit is configured to provide a second sensed physiological signal, wherein the second sensed physiological signal is representative of at least one of;
weight of the subject, respiration of the subject, a heart sound of the subject, arterial blood pressure of the subject, an indication of peripheral edema of the subject, thoracic fluid present in the subject, or a level of biochemical analyte present in the subject;a measurement circuit configured to recurrently measure one or more physiological parameters of a subject that indicate a status of heart failure of the subject, including a first physiological parameter using the first sensed physiological signal and a second physiological parameter using the second sensed physiological signal, wherein the second physiological parameter includes at least one of a measured weight of the subject, a respiration parameter of the subject, a magnitude of a heart sound, a time interval between a first heart sound signal feature and a second heart sound signal feature, a measured arterial blood pressure of the subject, a measure of edema of the subject, or an indication of a level of biochemical analyte present in the subject; a comparison circuit configured to compare the first physiological parameter to a target first physiological parameter value and the second physiological parameter to a target second physiological parameter value and provide an indication of an outcome of a comparison; a therapy circuit configured to control delivery of one or more drugs to treat heart failure; and a control circuit in electrical communication with the comparison circuit and the therapy circuit and configured to adjust delivery of the drug therapy according to the outcome of the comparison of the first and second physiological parameters to the target first and second physiological parameter values. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A method comprising:
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generating at least a first sensed physiological signal using an implantable physiological sensing circuit and at least a second sensed physiological signal using an external sensing circuit, wherein the external sensing circuit provides a physiological signal representative of at least one of a weight of the subject, arterial blood pressure of the subject, a measure of peripheral edema of the subject, or a level of biochemical analyte present in the subject; measuring at least a first physiological parameter indicative of a status of heart failure of the subject using the first sensed physiological signal and at least a second physiological parameter using the second sensed physiological signal, wherein the second physiological parameter includes at least one of a measured weight of the subject, a measured arterial blood pressure of the subject, a measure of peripheral edema of the subject, or a measure of a level of biochemical analyte present in the subject; comparing the first physiological parameter to a target first physiological parameter value and comparing the second physiological parameter to a target second physiological parameter value using a device that provides a drug therapy to treat heart failure; and recurrently adjusting a drug therapy according to the comparison of the first and second physiological parameters to the target first and second physiological parameter values. - View Dependent Claims (14, 15, 16, 17)
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18. An apparatus comprising:
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one or more physiological sensing circuits configured to generate a sensed physiological signal that includes physiological information, and wherein at least one of the physiological sensing circuits includes an implantable sensing circuit configured to generate a physiological signal indicative of a level of a biochemical analyte present in the subject, a measurement circuit configured to recurrently measure one or more physiological parameters of a subject using one or more of the sensed physiological signals including the level of biochemical analyte, wherein the one or more physiological parameters indicate a status of heart failure of the subject; a comparison circuit configured to compare the one or more physiological parameter measurements to one or more physiological parameter target values and provide an indication of an outcome of a comparison of the indicated level of biochemical analyte to a target level of the biochemical analyte; a therapy circuit configured to control delivery of one or more drugs to treat heart failure; and a control circuit in electrical communication with the comparison circuit and the therapy circuit and configured to recurrently adjust delivery of drug therapy according to the comparison of the measured physiological parameters to the physiological parameter targets.
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Specification