Remote closed-loop titration of decongestive therapy for the treatment of advanced heart failure
First Claim
1. An apparatus comprising:
- a cardiac therapy circuit configured to provide electrical cardiac therapeutic stimuli to treat cardiac arrhythmia;
including biventricular pacing therapy;
a drug therapy circuit configured to control delivery of one or more of diuretic agents and inotropic agents to treat heart failure;
a cardiac signal sensing circuit configured to generate a sensed cardiac activity signal;
a measurement circuit configured to recurrently measure a first physiological parameter of a subject using the sensed cardiac activity signal, wherein the first physiological parameter indicates a status of heart failure of the subject;
a comparison circuit configured to compare a measured value of the first physiological parameter to a first physiological parameter target value; and
a control circuit in electrical communication with the comparison circuit, the drug therapy circuit, and the cardiac therapy circuit, and configured to initiate closed loop delivery of drug therapy to treat heart failure of the subject using the drug therapy circuit, initiate measurement of the first physiological parameter after a specified number of cardiac cycles after the delivery, recurrently initiate a comparison of the measured value of the first physiological parameter to the first physiological parameter target value, recurrently adjust the drug therapy to move the measured value of the first physiological parameter toward the target value according to the comparison, and change at least one of a biventricular pacing delay parameter or a cardiac electrode site selection parameter to move the measured value of the first physiological parameter toward the target value.
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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.
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Citations
18 Claims
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1. An apparatus comprising:
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a cardiac therapy circuit configured to provide electrical cardiac therapeutic stimuli to treat cardiac arrhythmia;
including biventricular pacing therapy;a drug therapy circuit configured to control delivery of one or more of diuretic agents and inotropic agents to treat heart failure; a cardiac signal sensing circuit configured to generate a sensed cardiac activity signal; a measurement circuit configured to recurrently measure a first physiological parameter of a subject using the sensed cardiac activity signal, wherein the first physiological parameter indicates a status of heart failure of the subject; a comparison circuit configured to compare a measured value of the first physiological parameter to a first physiological parameter target value; and a control circuit in electrical communication with the comparison circuit, the drug therapy circuit, and the cardiac therapy circuit, and configured to initiate closed loop delivery of drug therapy to treat heart failure of the subject using the drug therapy circuit, initiate measurement of the first physiological parameter after a specified number of cardiac cycles after the delivery, recurrently initiate a comparison of the measured value of the first physiological parameter to the first physiological parameter target value, recurrently adjust the drug therapy to move the measured value of the first physiological parameter toward the target value according to the comparison, and change at least one of a biventricular pacing delay parameter or a cardiac electrode site selection parameter to move the measured value of the first physiological parameter toward the target value. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. A method of operating a medical device system, the method comprising:
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recurrently measuring, using an implantable medical device, a first physiological parameter of a subject using a sensed cardiac activity signal, wherein the first physiological parameter indicates a status of heart failure of the subject; and delivering closed loop device-based drug therapy to the subject, the closed-loop device-based drug therapy including; initiating delivery of the drug therapy, initiating measurement of the first physiological parameter after a specified number of cardiac cycles after the delivery of drug therapy, recurrently initiating a comparison of measured value of the first physiological parameter to a first physiological parameter target value, adjusting the drug therapy to move the measured value of the first physiological parameter toward the target value, and adjusting at least one of a biventricular pacing delay parameter or a cardiac electrode site selection parameter to move the measured value of the first physiological parameter toward the target value according to a comparison using the measurement. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18)
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Specification