Automated method for diagnosing and monitoring the outcomes of atrial fibrillation
First Claim
1. An automated method for diagnosing and monitoring an outcome of atrial fibrillation, comprising:
- retrieving a plurality of monitoring sets from a database with each monitoring set comprising recorded measures relating to patient information recorded on a substantially continuous basis;
diagnosing atrial fibrillation;
determining a patient status change in response to the atrial fibrillation diagnosis for an absence, an onset, a progression, a regression, and a status quo of atrial fibrillation by comparing at least one of the recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
testing the recorded measure comparison against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared to form the atrial fibrillation pathophysiological outcome, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation.
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Abstract
An automated system and method for diagnosing and monitoring the outcomes of atrial fibrillation is described. A plurality of monitoring sets is retrieved from a database. Each of the monitoring sets include recorded measures relating to patient information recorded on a substantially continuous basis. A patient status change is determined in response to an atrial fibrillation diagnosis by comparing at least one recorded measure from each of the monitoring sets to at least one other recorded measure. Both recorded measures relate to the same type of patient information. Each patient status change is tested against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared. The indicator threshold corresponds to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation.
284 Citations
62 Claims
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1. An automated method for diagnosing and monitoring an outcome of atrial fibrillation, comprising:
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retrieving a plurality of monitoring sets from a database with each monitoring set comprising recorded measures relating to patient information recorded on a substantially continuous basis;
diagnosing atrial fibrillation;
determining a patient status change in response to the atrial fibrillation diagnosis for an absence, an onset, a progression, a regression, and a status quo of atrial fibrillation by comparing at least one of the recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
testing the recorded measure comparison against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared to form the atrial fibrillation pathophysiological outcome, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
managing the atrial fibrillation diagnosis through administration of at least one of ventricular rate response control and normal sinus rhythm restoration.
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3. An automated method according to claim 1, further comprising:
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periodically receiving a monitoring set for an individual patient, each recorded measure in the monitoring set having been recorded by at least 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.
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4. An automated method according to claim 3, further comprising:
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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 atrial fibrillation;
comparing the patient status change to the 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 the patient status change against each such further indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.
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5. An automated method according to claim 1, further comprising:
determining a change in patient status by comparing one or more recorded quality of life measure to one or more other corresponding recorded quality of life measure.
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6. An automated method according to claim 1, further comprising:
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defining a set of stickiness indicators for the 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 the patient status change for the 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 the patient status change occurring subsequent to a time span exceeding the stickiness indicator.
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7. An automated method according to claim 1, 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.
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8. An automated method according to claim 1, further comprising:
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retrieving a reference baseline comprising recorded measures with each recorded measure relating to patient information recorded during an initial time period and each recorded measure comprising either medical device measures or derived measures calculable therefrom; and
obtaining at least one of the recorded measures and at least one other of the recorded measures from the retrieved reference baseline.
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9. An automated method according to claim 1, wherein the indicator threshold relates to at least one of a finding of reduced exercise capacity, respiratory distress and palpitations/symptoms.
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10. An automated method according to claim 9, wherein the indicator thresholds relating to the finding of reduced exercise capacity are selected from decreased cardiac output, decreased mixed venous oxygen score and decreased patient activity score.
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11. An automated method according to claim 9, wherein the indicator thresholds relating to the finding of respiratory distress are selected from increased pulmonary artery diastolic pressure, increased respiratory rate and decreased transthoracic impedance.
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12. A computer-readable storage medium containing code for an automated method for diagnosing and monitoring an outcome of atrial fibrillation, the code having instructions comprising:
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code for retrieving a plurality of monitoring sets from a database with each monitoring set comprising recorded measures relating to patient information recorded on a substantially continuous basis;
code for diagnosing atrial fibrillation;
code for determining a patient status change in response to the atrial fibrillation diagnosis for an absence, an onset, a progression, a regression, and a status quo of atrial fibrillation by comparing at least one of the recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
code for testing the recorded measure comparison against an indicator threshold corresponding to the same type of patient information as the recorded measures which were compared to form the atrial fibrillation pathophysiological outcome, the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19)
code for diagnosing atrial fibrillation through administration of at least one of ventricular rate response control and normal sinus rhythm restoration.
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14. A storage medium according to claim 12, the code further comprising:
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code for periodically receiving a monitoring set for an individual patient, each recorded measure in the monitoring set having been recorded by at least 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 storing the received monitoring set in the database as part of a patient care record for the individual patient.
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15. A storage medium according to claim 14, further comprising:
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code for 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 atrial fibrillation;
code for comparing the patient status change to the 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
code for testing the patient status change against each such further indicator threshold corresponding to the same type of patient information as the recorded measures which were compared.
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16. A storage medium according to claim 12, the code further comprising:
code for determining a change in patient status by comparing one or more recorded quality of life measure to one or more other corresponding recorded quality of life measure.
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17. A storage medium according to claim 12, the code further comprising:
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code for defining a set of stickiness indicators for the patient measures, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;
code for comparing a time span occurring between the patient status change for the recorded measure to the stickiness indicator relating to the same type of patient information as the recorded measure being compared; and
code for determining a revised program of patient diagnosis or treatment responsive to the patient status change occurring subsequent to a time span exceeding the stickiness indicator.
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18. A storage medium according to claim 12, the code further comprising:
code for 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.
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19. A storage medium according to claim 12, the code further comprising:
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code for retrieving a reference baseline comprising recorded measures with each recorded measure relating to patient information recorded during an initial time period and each recorded measure comprising either medical device measures or derived measures calculable therefrom; and
code for obtaining at least one of the recorded measures and the-at least one other of the recorded measures from the retrieved reference baseline.
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20. An automated collection and analysis patient care system for diagnosing and monitoring an of atrial fibrillation, comprising:
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a database to store a plurality of monitoring sets, each monitoring set comprising recorded measures with each recorded measure relating to patient information and each recorded measure comprising either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;
a set of stored indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation and relating to the same type of patient information as at least one of the recorded measures; and
a diagnostic module to diagnose atrial fibrillation;
an analysis module to determine a change in patient status status in response to the atrial fibrillation diagnosis for an absence, an onset, a progression, a regression, and a status quo of atrial fibrillation by comparing at least one of the recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
a comparison module to compare the patient status change to at least one of the indicator thresholds corresponding to the same type of patient information as the recorded measures which were compared. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33)
at least one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient to record the device measures.
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22. A system according to claim 20, wherein at least one of the monitoring sets comprises recorded measures relating to patient information solely for the individual patient, the system further comprising:
a database module to retrieve each monitoring set for the individual patient and obtaining at least one of the recorded measures from the at least one of the monitoring sets and at least one of the other recorded measures from the retrieved monitoring sets.
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23. A system according to claim 20, wherein at least one of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, the system further comprising:
a database module to retrieve at least one of the monitoring sets for the individual patient, retrieving at least one other of the monitoring sets in the same patient peer group, and obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the at least one other monitoring set.
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24. A system according to claim 20, wherein at least one of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, the system further comprising:
a database module to retrieve at least one of the monitoring sets for the individual patient, retrieving at least one other of the monitoring sets in the overall patient population, and obtaining at least one of the recorded measures from the at least one monitoring set and the-at least one of the other recorded measures from the at least one other monitoring set.
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25. A system according to claim 20, the system further comprising:
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the database further to store a reference baseline comprising recorded measures with each recorded measure relating to patient information recorded by the medical device adapted to be implanted during an initial time period and each recorded measure comprising either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and
a database module to obtain at least one of the recorded measures and the-at least one other of the recorded measures from the reference baseline.
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26. A system according to claim 25, 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.
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27. A system according to claim 20, the comparison module further comprising:
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a module to grade comparisons between each the patient status change and the corresponding indicator threshold on a fixed scale by performing a degree of deviation from the indicator threshold; and
the comparison module to determine an overall patient status change by performing a summation over the comparisons.
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28. A system according to claim 20, the comparison module further comprising:
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a module to determine probabilistic weightings of comparisons between each the patient status change and the corresponding indicator threshold by performing a statistical deviation and trends via linear fits from the indicator threshold; and
the comparison module to determine an overall patient status change by performing a summation over each of the comparisons.
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29. A system according to claim 20, wherein at least one monitoring set further comprises recorded quality of life and symptom measures, the diagnostic module further comprising:
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a quality of life module to determine a change in the patient status by comparing at least one of the recorded quality of life measures in the database to at least one of the other corresponding recorded quality of life measures; and
the diagnostic module to incorporate the patient status change in quality of life into the atrial fibrillation finding to either refute or support the diagnosis.
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30. A system according to claim 20, the system further comprising:
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a set of stored further indicator thresholds, each of the further indicator thresholds corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation; and
the diagnostic module to diagnose a finding of a disease other than atrial fibrillation by further comparing the patient status change to the such further indicator threshold corresponding to the same type of patient information as the at least the one recorded measure and the at least the one other recorded measure.
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31. A system according to claim 20, the system further comprising:
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a set of stickiness indicators, each of the stickiness indicators corresponding to a temporal limit related to a course of patient care; and
a feedback module to compare a time span between the 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.
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32. A system according to claim 20, the system further comprising:
a feedback module to provide automated feedback to an individual patient when an atrial fibrillation is diagnosed.
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33. A system according to claim 32, the system further comprising:
the feedback module to perform an interactive dialogue between the individual patient and the patient care system.
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34. A method for diagnosing and monitoring an outcome of atrial fibrillation using an automated collection and analysis patient care system, the method comprising:
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retrieving a plurality of monitoring sets from a database, each of the monitoring set comprising recorded measures with each recorded measure relating to patient information and each recorded measure comprising either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;
defining a set of indicator thresholds, each of the indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation and relating to the same type of patient information as at least one of the recorded measures; and
diagnosing atrial fibrillation;
determining a change in patient status status in response to the atrial fibrillation diagnosis for an absence, an onset, a progression, a regression, and a status quo of atrial fibrillation by comparing at least one of the recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
comparing the patient status change to at least one of the indicator thresholds corresponding to the same type of patient information as the recorded measures which were compared. - View Dependent Claims (35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 54)
recording the device measures by at least one of a medical device adapted to be implanted in an individual patient and an external medical device proximal to the individual patient.
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36. A method according to claim 35, wherein at least one of the monitoring sets comprises recorded measures relating to patient information solely for the individual patient, the method further comprising:
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retrieving each monitoring set for the individual patient; and
obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the retrieved monitoring sets.
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37. A method according to claim 34, wherein at least one of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, the method further comprising:
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retrieving at least one of the monitoring sets for the individual patient;
retrieving at least one other of the monitoring sets in the same patient peer group; and
obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the at least one other monitoring set.
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38. A method according to claim 34, wherein at least one of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, the method further comprising:
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retrieving at least one of the monitoring sets for the individual patient;
retrieving at least one other of the monitoring sets in the overall patient population; and
obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the at least one other monitoring set.
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39. A method according to claim 34, further comprising:
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retrieving a reference baseline, the reference baseline comprises recorded measures with each recorded measure relating to patient information recorded by the medical device adapted to be implanted during an initial time period and each recorded measure comprising either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and
obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the reference baseline.
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40. A method according to claim 39, 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.
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41. A method according to claim 34, wherein the operation of comparing the patient status change further comprises:
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grading the comparisons between the patient status change and corresponding indicator threshold on a fixed scale by performing a degree of deviation from the indicator threshold; and
determining an overall patient status change by performing a summation over the comparisons.
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42. A method according to claim 34, wherein the operation of comparing the patient status change further comprises:
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determining probabilistic weightings of comparisons between the patient status change and corresponding indicator threshold by performing a statistical deviation and trends via linear fits from the indicator threshold; and
determining an overall patient status change by performing a summation over each of the comparisons.
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43. A method according to claim 34, wherein at least one of the monitoring sets further comprises recorded quality of life and symptom measures, the operation of diagnosing an atrial fibrillation finding further comprising:
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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 the patient status change in quality of life into the atrial fibrillation finding to either refute or support the diagnosis.
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44. A method according to claim 34, further comprising:
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defining a set of further indicator thresholds, each further indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation; and
diagnosing a finding of the disease other than atrial fibrillation, comprising comparing the 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.
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45. A method according to claim 34, further comprising:
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defining a set of stickiness indicators, each of the stickiness indicators corresponding to a temporal limit related to a course of patient care; and
comparing a time span between the 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.
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46. A method according to claim 34, further comprising:
providing automated feedback to an individual patient when atrial fibrillation is diagnosed.
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47. A method according to claim 46, further comprising:
performing an interactive dialogue between the individual patient and the patient care system.
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54. A storage medium according to claim 37, wherein the operation of comparing the patient status change, the code further comprises:
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code for determining probabilistic weightings of comparisons between the patient status change and corresponding indicator threshold by performing a statistical deviation and trends via linear fits from the indicator threshold; and
code for determining an overall patient status change by performing a summation over the comparisons.
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48. A computer-readable storage medium holding code for diagnosing and monitoring an outcome of atrial fibrillation using an automated collection and analysis patient care system, the code having instructions comprising:
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code for retrieving a plurality of monitoring sets from a database, each monitoring set comprising recorded measures with each recorded measure relating to patient information and each recorded measure comprising either medical device measures or derived measures calculable therefrom, the medical device measures having been recorded on a substantially continuous basis;
code for defining a set of indicator thresholds, each indicator threshold corresponding to a quantifiable physiological measure of a pathophysiology resulting from atrial fibrillation and relating to the same type of patient information as at least one of the recorded measures; and
code for diagnosing atrial fibrillation;
code for determining a change in patient status status in response to the atrial fibrillation diagnosis for an absence, an onset, a progression, a regression, and a status quo of atrial fibrillation by comparing at least one of the recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
code for comparing the patient status change to at least one of the indicator thresholds corresponding to the same type of patient information as the recorded measures which were compared. - View Dependent Claims (49, 50, 51, 52, 53, 55, 56, 57, 58, 59)
code for retrieving each monitoring set from for the individual patient; and
code for obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the retrieved monitoring sets.
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50. A storage medium according to claim 48, wherein at least one of the monitoring sets comprises recorded measures relating to patient information for a peer group of patients to which the individual patient belongs, the code further comprising:
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code for retrieving at least one of the monitoring sets for the individual patient;
code for retrieving at least one other of the monitoring sets in the same patient peer group; and
code for obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the at least one other monitoring set.
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51. A storage medium according to claim 48, wherein at least one of the monitoring sets comprises recorded measures relating to patient information for the general population of patients, the code further comprising:
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code for at least one of the monitoring sets for the individual patient;
code for retrieving at least one other of the monitoring sets in the overall patient population; and
code for obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the at least one other monitoring set.
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52. A storage medium according to claim 48, code further comprising:
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code for retrieving a reference baseline, the reference baseline comprises comprising recorded measures with each recorded measure relating to patient information recorded by the medical device adapted to be implanted during an initial time period and each recorded measure comprising either device measures recorded by the medical device adapted to be implanted or derived measures calculable therefrom; and
code for obtaining at least one of the recorded measures from the at least one monitoring set and at least one of the other recorded measures from the reference baseline.
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53. A storage medium according to claim 48, wherein the operation of comparing the patient status change, the code further comprises:
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code for grading the comparisons between the patient status change and corresponding indicator threshold on a fixed scale by performing a degree of deviation from the indicator threshold; and
code for determining an overall patient status change by performing a summation over the comparisons.
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55. A storage medium according to claim 48, wherein at least one of the monitoring sets further comprises quality of life and symptom measures recorded by an individual patient, the operation of diagnosing an atrial fibrillation finding, the code further comprising:
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code for 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 incorporating the patient status change in quality of life into the atrial fibrillation finding to either refute or support the diagnosis.
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56. A storage medium according to claim 48, the code further comprising:
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code for defining a set of further indicator thresholds, each further indicator threshold corresponding to a quantifiable physiological measure used to detect a pathophysiology indicative of diseases other than atrial fibrillation; and
code for diagnosing a finding of the disease other than atrial fibrillation, comprising comparing the 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.
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57. A storage medium according to claim 48, the code further comprising:
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code for defining a set of stickiness indicators, each of the stickiness indicators corresponding to a temporal limit related to a course of patient care; and
code for comparing a time span between the 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.
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58. A storage medium according to claim 48, the code further comprising:
code for providing automated feedback to the an individual patient when an atrial fibrillation is diagnosed.
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59. A storage medium according to claim 48, the code further comprising:
code for performing an interactive dialogue between the individual patient and the patient care system.
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60. An automated patient care system for diagnosing and monitoring an outcome of atrial fibrillation the system comprising:
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a diagnostic module to diagnose atrial fibrillation;
a database to store recorded measures organized into a monitoring set for an individual patient with each recorded measure having been recorded on a substantially continuous basis and relating to at least one of monitoring reduced exercise capacity and respiratory distress;
a database module to periodically retreive a plurality of the monitoring sets from the database; and
an evaluation module to evaluate at least one of atrial fibrillation onset, progression, regression, and status quo;
a comparison module to determine a patient status change in response to an atrial fibrillation diagnosis by comparing at least of the one recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
an analysis module to test the patient status change against an indicator threshold corresponding to the same 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 reduced exercise capacity and respiratory distress.
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61. A method for diagnosing and monitoring the an outcome of atrial fibrillation in an automated patient care system the method comprising:
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diagnosing atrial fibrillation;
storing recorded measures organized into a monitoring set for an individual patient into a database with each recorded measure having been recorded on a substantially continuous basis and relating to at least one of monitoring reduced exercise capacity and respiratory distress;
periodically retrieving a plurality of the monitoring sets from the database;
evaluating at least one of atrial fibrillation onset, progression, regression, and status quo;
determining a patient status change in response to an atrial fibrillation by comparing at least of the one recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
testing the patient status change against an indicator threshold corresponding to the same 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 reduced exercise capacity and respiratory distress.
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62. A computer-readable storage medium holding code for diagnosing and monitoring an outcome of atrial fibrillation in an automated patient care system, the code having instructions comprising:
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code for diagnosing atrial fibrillation;
code for storing recorded measures organized into a monitoring set for an individual patient into a database with each recorded measure having been recorded on a substantially continuous basis and relating to at least one of monitoring reduced exercise capacity and respiratory distress;
code for periodically retrieving a plurality of the monitoring sets from the database;
code for evaluating at least one of atrial fibrillation onset, progression, regression, and status quo;
code for determining a patient status change in response to an atrial fibrillation diagnosis by comparing at least of the one recorded measures from each of the monitoring sets to at least one other of the recorded measures with both recorded measures relating to the same type of patient information; and
code for testing the patient status change against an indicator threshold corresponding to the same 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 reduced exercise capacity and respiratory distress.
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Specification