Systems and methods for detecting medical treatment

• US 9,826,939 B2
• Filed: 06/30/2015
• Issued: 11/28/2017
• Est. Priority Date: 07/01/2014
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Averina, Viktoria A., Thakur, Pramodsingh Hirasingh, Sweeney, Robert J.
• Primary Examiner(s): Wieland, Robert N
• Application Number:
  US14/755,150
• Publication Number:
  US 20160000380A1
• Time in Patent Office: 882 Days
• 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 5/0537 Measuring body composition by impedance, e.g. tissue hydration or fat content
• CPC Class Codes: A61B 5/091 Measuring volume of inspired or expired gases, e.g. to determine lung capacity
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61B 5/4839 combined with drug delivery
• CPC Class Codes: A61B 5/4848 Monitoring or testing the effects of treatment, e.g. of medication
• CPC Class Codes: A61B 5/4857 Indicating the phase of biorhythm clocks or watches with indicators for biological cycles G04B19/264
• 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 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• 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 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36528 the parameter being measured by means of ultrasound
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: G16H 20/00 ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

Systems and methods are provided for using stored physiologic information about a subject to detect a previous treatment event. Physiologic information can be sensed from a subject using one or more sensors. Using a detection circuit, a change in the sensed physiologic information, such as a change from reference physiologic information, can be used to identify a candidate previous treatment event. An alert or other information about the candidate treatment event can be provided to a patient or clinician. In an example, a candidate treatment event can include a heart failure or diuresis treatment that is identified using information about a change in one or more of a subject'"'"'s circadian pattern, a subject'"'"'s thoracic impedance, or a subject'"'"'s respiration status.

Claims

1. A system for detecting a previous or ongoing treatment of a subject, the system comprising:

a first physiologic sensor configured to sense a physiologic signal from the subject; and

a previous treatment detection circuit, the treatment detection circuit including;

a memory circuit configured to store information about the physiologic signal from the first physiologic sensor; and

a processor circuit configured to identify a candidate previous treatment event for the subject using the information about the physiologic signal stored in the memory circuit.

2. The system of claim 1, wherein the previous treatment detection circuit includes a heart failure (HF) hospitalization treatment detection circuit, and wherein the processor circuit is configured to identify a candidate previous HF hospitalization treatment event for the subject using the information about the physiologic signal stored in the memory circuit.

3. The system of claim 1, wherein the previous treatment detection circuit includes a diuresis treatment detection circuit, and wherein the processor circuit is configured to identify a candidate previous diuresis treatment event for the subject using the information about the physiologic signal stored in the memory circuit.

4. The system of claim 1, wherein the previous treatment detection circuit includes one of an extracellular volume reduction treatment detection circuit, a heart failure (HF) inotrope treatment detection circuit, and a fluid infusion detection circuit.

5. The system of claim 1, wherein the first physiologic sensor is configured to sense a physiologic signal that includes information about the subject'"'"'s circadian rhythm, and wherein the processor circuit is configured to identify the candidate previous treatment event by identifying a change in the subject'"'"'s circadian rhythm.

6. The system of claim 5, wherein the first physiologic sensor includes an accelerometer that is configured to sense the physiologic signal including being configured to sense the information about the subject'"'"'s circadian rhythm using information about the subject'"'"'s posture and using information about the subject'"'"'s physical activity level.

7. The system of claim 1, wherein the first physiologic sensor is configured to sense a physiologic signal that includes information about the subject'"'"'s thoracic impedance, and wherein the processor circuit is configured to identify the candidate previous treatment event using an inter-day trend in the information about the subject'"'"'s thoracic impedance.

8. The system of claim 1, wherein the first physiologic sensor is configured to sense a physiologic signal that includes information about the subject'"'"'s respiration status, and wherein the processor circuit is configured to identify the candidate previous treatment event using information about a change in the information about the subject'"'"'s respiration status.

9. The system of claim 1, wherein the first physiologic sensor is configured to sense a physiologic signal that includes information about a heart sound of the subject, and wherein the processor circuit is configured to identify the candidate previous treatment event by identifying a change in the information about the subject'"'"'s heart sound.

10. The system of claim 1, comprising:

an impedance sensor configured to sense a thoracic impedance signal from the subject; and

a respiration sensor configured to sense a respiration status signal from the subject;

wherein the first physiologic sensor includes an accelerometer configured to sense information about the subject'"'"'s circadian rhythm, wherein the processor circuit is configured to identify a circadian pattern signal from the subject;

wherein the memory circuit is configured to store information about each of the thoracic impedance signal, the respiration status signal, and the circadian pattern signal from the subject; and

wherein the processor circuit is configured to identify the candidate previous treatment event using information about a change in at least one of the subject'"'"'s thoracic impedance, the subject'"'"'s respiration status, and the subject'"'"'s circadian pattern, based on the information stored in the memory circuit about the thoracic impedance signal, the respiration status signal, and the circadian pattern signal.

11. The system of claim 1, wherein the processor circuit is configured to determine a likelihood that the identified candidate previous treatment event corresponds to an actual previous HF hospitalization treatment event or diuresis treatment event.

12. A method for detecting a previous or ongoing treatment of a subject, the method comprising:

receiving, using an ambulatory medical device, physiologic status information about the subject over a first duration from a first physiologic sensor;

recording the received physiologic status information about the subject using a memory circuit coupled to the ambulatory medical device; and

identifying a candidate previous treatment event for the subject using a processor circuit and the recorded physiologic status information about the subject from the memory circuit.

13. The method of claim 12, wherein the identifying the candidate previous treatment event includes identifying a candidate HF hospitalization treatment using the processor circuit and using the recorded physiologic status information about the subject from the memory circuit.

14. The method of claim 12, wherein the identifying the candidate previous treatment event includes identifying a candidate diuresis treatment using the processor circuit and using the recorded physiologic status information about the subject from the memory circuit.

15. The method of claim 12, wherein the identifying the candidate previous treatment event includes identifying, in the recorded physiologic status information, first and second changes in the received physiologic status information, the first and second changes occurring within a specified duration.

16. The method of claim 12, comprising determining a likelihood that the identified candidate previous treatment event corresponds to an actual treatment event, and, when the likelihood exceeds a specified threshold likelihood, providing information about the identified candidate treatment event to a patient interface or to a clinician interface.

17. The method of claim 12, wherein the recording the received physiologic status information about the subject includes recording information about the subject'"'"'s circadian pattern over the first duration using the first physiologic sensor;

and

wherein the identifying the candidate previous treatment event using the processor circuit includes using the processor circuit to identify a relationship between a reference and;

a timing characteristic of the subject'"'"'s circadian pattern;

a severity characteristic of the subject'"'"'s circadian pattern;

or a likelihood that a change in the subject'"'"'s circadian rhythm indicates an actual HF treatment event.

18. The method of claim 12, wherein the recording the received physiologic status information about the subject includes recording information about the subject'"'"'s thoracic impedance over the first duration using the first physiologic sensor;

and

wherein the identifying the candidate previous treatment event using the processor circuit includes using the processor circuit to identify a relationship between a reference and;

a magnitude of the subject'"'"'s thoracic impedance;

a change rate characteristic of the subject'"'"'s thoracic impedance magnitude;

or a likelihood that a change in the subject'"'"'s thoracic impedance magnitude indicates an actual HF treatment event.

19. The method of claim 12, wherein the recording the received physiologic status information about the subject includes recording information about the subject'"'"'s respiration status over the first duration using the first physiologic sensor;

and

wherein the identifying the candidate previous treatment event using the processor circuit includes using the processor circuit to identify a relationship between a reference and;

a timing characteristic of the subject'"'"'s tidal volume;

the subject'"'"'s average tidal volume;

the subject'"'"'s rapid shallow breathing index;

a change rate characteristic of the subject'"'"'s tidal volume;

or a likelihood that a change in the subject'"'"'s tidal volume indicates an actual HF treatment event.

20. A system comprising:

an ambulatory medical device, comprising;

a data input configured to receive a physiologic signal from a physiologic sensor, the physiologic sensor configured to sense information about a subject'"'"'s physiologic status;

a memory circuit configured to store information about the physiologic signal received using the data input; and

a processor circuit configured to identify a candidate previous heart failure treatment event using the information about the physiologic signal stored in the memory circuit;

wherein the processor circuit is configured to identify a likelihood that the identified candidate previous heart failure treatment event indicates an actual previous heart failure treatment event; and

wherein the processor circuit is configured to generate a treatment alert that includes physiologic signal information other than the information about the physiologic signal used by the processor circuit to identify the candidate previous treatment event.