DEVICE BASED OPTIMIZATION OF DEVICE THERAPIES

• US 20140277237A1
• Filed: 02/24/2014
• Published: 09/18/2014
• Est. Priority Date: 03/13/2013
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Maskara, Barun, An, Qi, Thakur, Pramodsingh Hirasingh, Thompson, Julie A.
• Application Number:
  US14/187,877
• Publication Number:
  US 20140277237A1
• Time in Patent Office: Days
• US Class Current: 607/18
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/0484 Garment electrodes worn by the patient
• CPC Class Codes: A61N 1/0492 Patch electrodes A61N1/0412, A61N1/0428 take precedence
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/37211 Means for communicating with stimulators

Abstract

A system may include an external medical device (e.g., a patch) including one or more physiological sensors configured to sense one or more physiological parameters of a subject when the subject is ambulatory. The external medical device may be configured to communicate information related to the sensed one or more physiological parameters for determining and/or modifying at least one cardiac therapy parameter of an implantable medical device (e.g., pacemaker, implantable cardioverter defibrillators, or cardiac resynchronization therapy device). In some situations, an indication or notification may be generated corresponding to the determined and/modified cardiac therapy parameter.

Claims

1. A system comprising:

an external medical device including;

one or more physiological sensors configured to sense one or more physiological parameters of a subject when the subject is ambulatory; and

a communication circuit configured to communicate information related to the sensed one or more physiological parameters with a separate second medical device; and

the second medical device including;

a communication circuit configured to receive the information related to the sensed one or more physiological parameters from the external medical device; and

a control circuit in electrical communication with the communication circuit and including a parameter circuit configured to determine a value of at least one programmable cardiac therapy parameter using the information related to the sensed one or more physiological parameters received from the external medical device.

2. The system of claim 1, wherein the external medical device is one of:

adherable on the subject, wearable by the subject, or incorporated into a garment.

3. The system of claim 1, wherein the second medical device includes at least one of a medical device communicator or a medical device programmer, and wherein the control circuit of the second medical device is configured to generate an indication of the determined therapy parameter value.

4. The system of claim 1, including an implantable medical device separate from the second medical device, wherein the implantable medical device includes:

a communication circuit configured to communicate with the second medical device; and

a therapy circuit configured to deliver at least one of cardiac pacing therapy or cardiac resynchronization therapy to the subject;

wherein the second medical device is configured to;

communicate a change in at least one pacing parameter to the implantable medical device;

initiate sensing by of the physiological information by the external medical device for multiple values of the at least one pacing parameter; and

determine a setting of the at least one pacing parameter using the physiological information sensed by the external medical device.

5. The system of claim 4, wherein the second medical device is configured to:

communicate, to the implantable medical device, a change to at least one of a pacing pulse magnitude, a time delay between an atrial event and a paced ventricular event (AV delay), or a time delay between a ventricular event and a paced ventricular event (VV delay), or a combination of electrodes used to deliver the cardiac pacing therapy; and

determine an optimum setting of the least one of the pacing pulse magnitude, the AV delay, the VV delay, or the combination of electrodes using the physiological information obtained by the external medical device.

6. The system of claim 1, including an implantable medical device separate from the second medical device, wherein the implantable medical device includes:

a communication circuit to communicate information with the second medical device; and

a therapy circuit configured to deliver autonomic stimulation therapy to the subject,

wherein the second medical device is configured to;

communicate, to the implantable medical device, a change to at least one of a stimulation pulse amplitude, a stimulation pulse width, a shape of stimulation, a frequency of stimulation, a duration of stimulation, or a combination of electrodes used to deliver the autonomic stimulation therapy when the external medical device is sensing physiological information; and

determine an optimum setting of the at least one of the stimulation pulse amplitude, the stimulation pulse width, the shape of stimulation, the frequency of stimulation, the duration of stimulation, or the combination of electrodes to deliver the autonomic stimulation therapy using the sensed physiological information.

7. The system of claim 1,

wherein the external medical device is configured to communicate, to the second medical device, physiological information associated with at least one of ventricular pressure, cardiac stroke volume, ejection fraction, or ventricular pre-load, and

wherein the parameter circuit is configured to adjust the programmable therapy parameter to optimize a device-calculated metric derived from one or more of ventricular pressure, cardiac stroke volume, ventricular pre-load.

8. The system of claim 1,

wherein the physiological sensor circuits include one or more of a heart sound sensing circuit configured to provide a sensed heart sound signal representative of mechanical cardiac activity, a lung sound sensing circuit, a respiration sensing circuit, a posture sensing circuit, an transthoracic impedance sensing circuit, a physical activity sensing circuit and a heart rate sensing circuit, and

wherein the external medical device is configured to communicate, to the second medical device, sensed physiological information associated with at least one of a heart sound of the subject, a lung sound of the subject, respiration of the subject, posture of the subject, transthoracic impedance of the subject, activity level of the subject or heart rate of the subject.

9. The system of claim 1, including a third medical device separate from the second medical device, wherein the third medical device includes:

a plurality of physiological sensor circuits;

a communication circuit to communicate information with the second medical device;

a therapy circuit configured to deliver cardiac therapy to the subject; and

a control circuit in electrical communication with the plurality of physiological sensors, the communication circuit, and the therapy circuit, wherein the control circuit is configured to initiate delivery of cardiac therapy to the subject and, when in a test mode, the control circuit is configured to;

vary a setting of the at least one programmable therapy parameter when the subject is ambulatory;

obtain physiological information when the subject is ambulatory and for multiple settings of the at least one programmable therapy parameter; and

communicate the physiological information to the second medical device,

wherein the parameter circuit of the second medical device is configured to determine a setting for the at least one programmable therapy parameter using the physiological information obtained by the third medical device and using physiological information obtained by the external medical device.

10. The system of claim 9,

wherein the physiological sensor circuits of the third medical device include one or more of a heart sound sensing circuit configured to provide a sensed heart sound signal representative of mechanical cardiac activity, a lung sound sensing circuit, a respiration sensing circuit, a posture sensing circuit, an transthoracic impedance sensing circuit, an intracardiac impedance sensing circuit, a physical activity level sensing circuit and a cardiac signal sensing circuit,

wherein the physiological information obtained by the third medical device when the subject is ambulatory and for multiple settings of the at least one pacing parameter includes physiological information associated with at least one of a heart sound, a lung sound, respiration, posture, heart rate, transthoracic impedance, intracardiac impedance, physical activity level and one or more time intervals between device-detected cardiac events.

11. The system of claim 9, wherein the parameter circuit of the second medical device is configured to align the physiological information communicated from the external medical device and the physiological information communicated from the third medical device.

12. The system of claim 1, wherein the second medical device is an implantable medical device, wherein the implantable medical device includes:

a plurality of physiological sensor circuits;

a therapy circuit configured to deliver cardiac pacing therapy to the subject;

the communication circuit configured to communicate information with the external medical device; and

the control circuit, wherein the control circuit is configured to initiate delivery of cardiac pacing therapy to the subject and, when in a test mode, the control circuit is configured to;

vary a setting of at least one pacing parameter when the subject is ambulatory;

initiate sensing of physiological information by the implantable medical device and by the external medical device for multiple settings of the at least one pacing parameter; and

receive sensed physiological information from the external medical device,

wherein the parameter circuit is configured to determine the setting for the at least one pacing parameter using physiological information sensed by the implantable medical device and using the physiological information received from the external medical device.

13. A method of operating a medical device system, the method comprising:

sensing, by an external medical device of the medical device system, one or more physiological parameters of a subject when the subject is ambulatory;

communicating physiological information related to the sensed one or more physiological parameters obtained by the external medical device to a second medical device of the medical device system; and

determining, by the second medical device, a setting of at least one programmable cardiac therapy parameter using the communicated physiological information related to the sensed one or more physiological parameters.

14. The method of claim 13, including:

providing, by an implantable medical device of the medical device system that is separate from the second medical device, at least one of cardiac pacing therapy or cardiac resynchronization therapy to the subject, wherein the at least one programmable therapy parameter includes at least one pacing parameter; and

initiating a change in the at least one pacing parameter using the second medical device, wherein the physiological information is obtained by the external medical device for multiple values of the at least one pacing parameter.

15. The method of claim 14, including:

varying, by the second medical device, at least one of a pacing pulse magnitude, a time delay between an atrial event and a paced ventricular event (AV delay), a time delay between a ventricular event and a paced ventricular event (VV delay), or a combination of electrodes used to deliver the cardiac pacing therapy when the external medical device is obtaining physiological information, and

wherein determining a setting for the at least one pacing parameter includes adjusting a setting of the least one of the pacing pulse magnitude, the AV delay, the VV delay, or the combination of electrodes using the communicated physiological information obtained by the external medical device.

16. The method of claim 13, including:

providing, by an implantable medical device of the medical device system that is separate from the second medical device, autonomic stimulation therapy;

varying, by the second medical device, at least one of a stimulation pulse amplitude, a stimulation pulse width, a shape of a stimulation signal, a frequency of stimulation, a duration of stimulation, or a combination of electrodes used to provide the autonomic stimulation therapy when the external medical device is obtaining physiological information, and

wherein determining a setting for at least one programmable therapy parameter includes determining an optimum setting of the least one of the stimulation pulse amplitude, the stimulation pulse width, the shape of stimulation, the frequency of stimulation, the duration of stimulation, or the combination of electrodes used to provide the autonomic stimulation therapy using the communicated physiological information obtained by the external medical device.

17. The method of claim 13,

wherein communicating physiological information obtained by the external medical device includes communicating physiological information of the subject associated with at least one of ventricular pressure, cardiac stroke volume, ejection fraction or pre-loading of a ventricle, and

wherein determining a setting for at least one programmable therapy parameter includes determining an optimum setting for the programmable therapy parameter to optimize a device-calculated metric derived from one or more of ventricular pressure, cardiac stroke volume, ejection fraction or pre-loading of the ventricle.

18. The method of claim 13, wherein communicating physiological information obtained by the external medical device includes communicating physiological information associated with at least one of a heart sound of the subject, a lung sound of the subject, respiration of the subject, posture of the subject, transthoracic impedance, activity level of the subject and heart rate of the subject obtained by the external medical device.

19. The method of claim 13,

sensing, by a third medical device of the medical device system that is separate from the second medical device, a plurality of physiological sensor signals when the subject is ambulatory;

and

providing, by the third device, cardiac therapy to the subject and varying the at least one programmable parameter of cardiac therapy when the subject is ambulatory, wherein the sensing by the external device and the implantable device occurs for multiple settings of the at least one programmable therapy parameter of cardiac therapy,

wherein communicating physiological information includes communicating physiological information from both the external medical device and the third medical device to the second medical device, and

wherein determining a setting includes determining, by the second medical device, the setting for the at least one programmable therapy parameter of cardiac therapy using the physiological information communicated by the external medical and using the physiological information communicated by the third medical device.

20. The method of claim 19, wherein communicating physiological information obtained by the third medical device includes communicating physiological information of the subject associated with at least one of a heart sound, a lung sound, respiration, posture, heart rate, transthoracic impedance, intracardiac impedance, activity level and one or more time intervals between device-detected cardiac events.