Abstract: In some examples, determining a heart failure status includes using an implantable medical device configured for subcutaneous implantation and comprising a plurality of electrodes and an optical sensor. Processing circuitry of a system comprising the device may determine, for a patient, a current tissue oxygen saturation value based on a signal received from the at least one optical sensor, a current tissue impedance value based on a subcutaneous tissue impedance signal received from the electrodes, and a current pulse transit time value based on a cardiac electrogram signal received from the electrodes and at least one of the signal received from the optical sensor and the subcutaneous tissue impedance signal. The processing circuitry may further compare the current tissue oxygen saturation value, current tissue impedance value, and current pulse transit time value to corresponding baseline values, and determine the heart failure status of the patient based on the comparison.

Abstract: In some examples, determining a heart failure status of a patient using a medical device comprising a plurality of electrodes includes determining an estimated arterial pressure waveform of the patient based on an arterial impedance signal received from at least two of the plurality of electrodes. The estimated arterial pressure waveform may comprise a plurality of arterial pressure cycles. Each of the plurality of arterial pressure cycles may correspond to a different cardiac cycle of a plurality of cardiac cycles of the patient. At least one value of an intrinsic frequency of the corresponding arterial pressure cycle may be determined for at least some of the plurality of cardiac cycles and the heart failure status of the patient may be determined based on the at least one value of the intrinsic frequency.

Abstract: In some examples, determining a heart failure status of a patient using a medical device comprising a plurality of electrodes includes determining an estimated arterial pressure waveform of the patient based on an arterial impedance signal received from at least two of the plurality of electrodes. The estimated arterial pressure waveform may comprise a plurality of arterial pressure cycles. Each of the plurality of arterial pressure cycles may correspond to a different cardiac cycle of a plurality of cardiac cycles of the patient. At least one value of an intrinsic frequency of the corresponding arterial pressure cycle may be determined for at least some of the plurality of cardiac cycles and the heart failure status of the patient may be determined based on the at least one value of the intrinsic frequency.

Abstract: Methods and systems for seamless adjustment of treatment are disclosed. A determination is made as to whether to intervene with a patient's treatment. Implanted device memory data is acquired over a pre-specified time period. Risk status is determined from the device memory data. Another external device memory data is acquired over a pre-specified time period. A determination is made as to whether to adjust treatment of the patient in response to the risk status, the data acquired from the implanted device memory and the external device memory data.

Abstract: A method for monitoring a cardiovascular pressure in a patient may include storing, in a memory of an implantable medical device system and in association with each one or more different patient postures, a respective offset value for the cardiovascular pressure of the patient. The one or more offset values may be determined based on a distance between an implantable pressure sensing device and an anatomical structure of the patient, a location of the implantable pressure sensing device within the patient, or one or more dimensions an anatomical structure of the patient. The method further includes determining a measured value of the cardiovascular pressure and a posture of the patient when the value of the cardiovascular pressure was measured, selecting a stored offset value associated with the current patient posture, and determining an adjusted cardiovascular pressure value based on the selected offset value and the measured cardiovascular pressure value.

Abstract: In some examples, determining a heart failure status includes using an implantable medical device configured for subcutaneous implantation and comprising a plurality of electrodes and an optical sensor. Processing circuitry of a system comprising the device may determine, for a patient, a current tissue oxygen saturation value based on a signal received from the at least one optical sensor, a current tissue impedance value based on a subcutaneous tissue impedance signal received from the electrodes, and a current pulse transit time value based on a cardiac electrogram signal received from the electrodes and at least one of the signal received from the optical sensor and the subcutaneous tissue impedance signal. The processing circuitry may further compare the current tissue oxygen saturation value, current tissue impedance value, and current pulse transit time value to corresponding baseline values, and determine the heart failure status of the patient based on the comparison.

Abstract: The present disclosure provides an apparatus and method of detecting ischemia with a pressure sensor. The method can include obtaining a pressure signal and determining a pressure rate of change. The method can also include identifying at least one of impaired relaxation and impaired contractility in order to detect ischemia.

Abstract: A method for monitoring a cardiovascular pressure in a patient may include storing, in a memory of an implantable medical device system and in association with each one or more different patient postures, a respective offset value for the cardiovascular pressure of the patient. The one or more offset values may be determined based on a distance between an implantable pressure sensing device and an anatomical structure of the patient, a location of the implantable pressure sensing device within the patient, or one or more dimensions an anatomical structure of the patient. The method further includes determining a measured value of the cardiovascular pressure and a posture of the patient when the value of the cardiovascular pressure was measured, selecting a stored offset value associated with the current patient posture, and determining an adjusted cardiovascular pressure value based on the selected offset value and the measured cardiovascular pressure value.

Abstract: An implantable medical device system and associated method for use in guiding an acute decompensated heart failure therapy set an optimal fluid status measurement level. A physiological sensor signal sensed by an implantable medical device is used to compute the fluid status measurement. A target rate of change of the fluid status measurement is computed for guiding the therapy.

Abstract: A medical device system including a physiological sensor and ultrafiltration unit senses a physiological signal in a patient and computes a fluid status measurement of the patient using the physiological signal. Ultrafiltration therapy is delivered to the patient according to a therapy delivery control parameter established in response to the fluid status measurement.

Abstract: Methods and systems for seamless adjustment of treatment are disclosed. A determination is made as to whether to intervene with a patient's treatment. Implanted device memory data is acquired over a pre-specified time period. Risk status is determined from the device memory data. Another external device memory data is acquired over a pre-specified time period. A determination is made as to whether to adjust treatment of the patient in response to the risk status, the data acquired from the implanted device memory and the external device memory data.

Abstract: A medical device system including a physiological sensor and ultrafiltration unit senses a physiological signal in a patient and computes a fluid status measurement of the patient using the physiological signal. Ultrafiltration therapy is delivered to the patient according to a therapy delivery control parameter established in response to the fluid status measurement.

Abstract: The present disclosure provides an apparatus and method of detecting ischemia with a pressure sensor. The method can include obtaining a pressure signal and determining a pressure rate of change. The method can also include identifying at least one of impaired relaxation and impaired contractility in order to detect ischemia.

Abstract: A medical device system including a physiological sensor and ultrafiltration unit senses a physiological signal in a patient and computes a fluid status measurement of the patient using the physiological signal. Ultrafiltration therapy is delivered to the patient according to a therapy delivery control parameter established in response to the fluid status measurement.

Abstract: The present disclosure provides an apparatus and method of detecting ischemia with a pressure sensor. The method can include obtaining a pressure signal and determining a pressure rate of change. The method can also include identifying at least one of impaired relaxation and impaired contractility in order to detect ischemia.

Abstract: An example system may include at least one pressure sensor configured to measure a cardiovascular pressure signal and another medical device configured to measure an electrical depolarization signal of the heart. The system determines a plurality of cardiovascular pressure metrics based on the measured cardiovascular pressure signal, including at least one cardiovascular pressure metric indicative of a timing of at least one cardiac pulse. The system also determines a metric indicative of a timing of at least one heart depolarization within the measured electrical depolarization signal. The system compares the timing of the at least one cardiac pulse to the timing of the at least one depolarization, and determines whether to discard the plurality of cardiovascular pressure metrics based on whether the timings substantially agree.

Abstract: An implantable medical device system and method provide physiological variable monitoring for use in patient management. A target value for a physiological variable and formulations for computing metrics of the physiological variable are stored. Values of the physiological variable are determined from a sensed physiological signal and are used to compute a selected metric. The metric is compared to the stored target value.

Abstract: A medical device system including a physiological sensor is configured to perform a method for detecting signal artifact in a signal waveform acquired by the sensor. A signal waveform is sensed in a patient using the physiological sensor and a fiducial point associated with the sensed waveform is identified. A point value is established using the fiducial point. Signal artifact is detected in response to the established point value and an established threshold, and at least a portion of the signal waveform is rejected in response to detecting signal artifact.

Abstract: A medical device monitors a patient to predict worsening heart failure. An input circuit of the medical device receives a pressure signal representative of a pressure sensed within a ventricle of the patient's heart as a function of time. A processor derives from the pressure signal a ventricular pressure index for a ventricular contraction based upon pressures in the ventricle. The processor then provides an output based upon the ventricular pressure index.

Abstract: A therapy regimen, e.g., a contingent medication prescription, may be created and automatically distributed to a patient via an integrated patient care system. A clinician may create therapy instructions by at least associating patient conditions with one or more therapy regimens, e.g., medication prescriptions. In some examples, the integrated patient care system may present historical condition data to the clinician to aid the clinician with creating and/or updating the therapy instructions specific to the patient. A therapy module of the integrated patient care system may use the therapy instructions to automatically select a therapy regimen from the therapy instructions based on a patient condition detected based on a sensed physiological parameter. The physiological parameter of the patient may be sensed by an implanted or external sensor. In some examples, the therapy regimen can be presented to the patient according to a predetermined schedule or in response to the detected condition.