Abstract: Systems and methods for detecting a present, or predicting a future, target physiologic event such as worsening heart failure (HF) are described. A system can comprise a patient information receiver circuit, at least two categorical risk analyzer circuits, and a categorical fusion circuit. The patient information receiver circuit receives physiologic signals and generates signal trends. The categorical risk analyzer circuit receives a category-specific input selected from the signal trends according to an associative physiologic condition indicative or correlative of the target event. The categorical risk analyzer circuit produces a signal trend metric indicating relative change in signal strength over time. The categorical risk analyzer circuit calculates a categorical risk index that indicates likelihood of the patient developing or presenting the associative physiologic condition.

Abstract: Assessing decongestive therapy delivered to a heart failure patient involves use of an implantable sensor configured to sense a physiologic parameter indicative of the patient's diuresis status and a processor coupled to the implantable sensor. The sensor may comprise a thoracic fluid sensor, a heart sounds sensor, a cardiac chamber or arterial pressure sensor, a respiration sensor, or a blood chemistry sensor, for example. The processor is configured to determine if a target level of patient diuresis has been achieved based on a relationship between the sensed physiologic parameter and a threshold developed for the patient, and to produce an output in response to determining that the target level of patient diuresis has been achieved. The processor may be disposed in an implantable housing, in a patient-external housing, or in a network server system.

Abstract: Devices and methods for improving device therapy such as cardiac resynchronization therapy by determining a value for a device parameter are described. An ambulatory medical device (AMD) can include a sensor circuit to sense a physiological signal and generate two or more signal metrics, and detect an event of worsening cardiac condition using the two or more signal metrics. In response to the detection of worsening cardiac condition, the AMD can determine, for a stimulator, a value of at least one stimulation parameter based on temporal responses of two or more signal metrics. The temporal responses include near-term and long-term responses to the stimulation. The AMD can program the stimulator with the determined parameter value, and generate stimulation according to the determined parameter value to stimulate target tissue.

Abstract: An apparatus comprises plurality of sensors and a processor. Each sensor provides a sensor signal that includes physiological information and at least one sensor is implantable. The processor includes a physiological change event detection module that detects a physiological change event from a sensor signal and produces an indication of occurrence of one or more detected physiological change events, and a heart failure (HF) detection module. The HF detection module determines, using a first rule, whether the detected physiological change event is indicative of a change in HF status of a subject, determines whether to override the first rule HF determination using a second rules, and declares whether the change in HF status occurred according to the first and second rules.

Abstract: An apparatus may include an implantable therapy circuit that provides bi-ventricular pacing to a subject, a heart sound signal sensing circuit that produces a sensed heart sound signal that is representative of at least one heart sound associated with mechanical cardiac activity, a memory circuit to store one or more heart sound templates of cardiac capture, and a comparison circuit that compares a segment of the sensed heart sound signal to the one or more heart sound templates of cardiac capture to identify ventricles in which cardiac capture was induced by the bi-ventricular pacing. In some situations, an indication of the ventricles in which cardiac capture was induced may be generated according to the comparison.

Abstract: Devices and methods for improving device therapy such as cardiac resynchronization therapy (CRT) by determining a desired value for a device parameter are described. An ambulatory medical device can receive one or more physiologic signals and generate multiple signal metrics from the physiologic signals. The ambulatory medical device can determine a desired value for a device parameter, such as a timing parameter used for controlling the delivery of CRT pacing to various heart chambers, using information fusion of signal metrics that are selected based on one or more of a signal metric sensitivity to perturbations to the device parameter in response to a stimulation, a signal metric variability in response to a stimulation, or a covariability between two or more signal metrics in response to a stimulation. The ambulatory medical device can program a stimulation using the desired device parameter value, and deliver the programmed stimulation to one or more target sites to achieve desired therapeutic effects.

Abstract: An apparatus may include an implantable therapy circuit that provides bi-ventricular pacing to a subject, a heart sound signal sensing circuit that produces a sensed heart sound signal that is representative of at least one heart sound associated with mechanical cardiac activity, a memory circuit to store one or more heart sound templates of cardiac capture, and a comparison circuit that compares a segment of the sensed heart sound signal to the one or more heart sound templates of cardiac capture to identify ventricles in which cardiac capture was induced by the bi-ventricular pacing. In some situations, an indication of the ventricles in which cardiac capture was induced may be generated according to the comparison.

Abstract: Systems and methods are described for subject rehospitalization management. In an example, multiple physiologic signals can be obtained from a subject using multiple sensors. In response to a hospitalization event, pre-hospitalization characteristics of the multiple physiologic signals can be identified. Post-hospitalization characteristics of the multiple physiologic signals can be identified, including characteristics that differ from their corresponding pre-hospitalization characteristics. Later subsequent physiologic signals can be further monitored after the hospitalization event, such as using the same multiple sensors, and subsequent physiologic signal characteristics can be identified. In an example, a heart failure diagnostic indication can be determined using information about the pre-hospitalization characteristics, the post-hospitalization characteristics, and the subsequent characteristics.

Abstract: Systems and methods are described for subject rehospitalization management. In an example, multiple physiologic signals can be obtained from a subject using multiple sensors. In response to a hospitalization event, pre-hospitalization characteristics of the multiple physiologic signals can be identified. Post-hospitalization characteristics of the multiple physiologic signals can be identified, including characteristics that differ from their corresponding pre-hospitalization characteristics. Later subsequent physiologic signals can be further monitored after the hospitalization event, such as using the same multiple sensors, and subsequent physiologic signal characteristics can be identified. In an example, a heart failure diagnostic indication can be determined using information about the pre-hospitalization characteristics, the post-hospitalization characteristics, and the subsequent characteristics.

Abstract: An apparatus may include an implantable therapy circuit that provides bi-ventricular pacing to a subject, a heart sound signal sensing circuit that produces a sensed heart sound signal that is representative of at least one heart sound associated with mechanical cardiac activity, a memory circuit to store one or more heart sound templates of cardiac capture, and a comparison circuit that compares a segment of the sensed heart sound signal to the one or more heart sound templates of cardiac capture to identify ventricles in which cardiac capture was induced by the bi-ventricular pacing. In some situations, an indication of the ventricles in which cardiac capture was induced may be generated according to the comparison.

Abstract: Devices and methods for improving device therapy such as cardiac resynchronization therapy (CRT) by determining a desired value for a device parameter are described. An ambulatory medical device can receive one or more physiologic signals and generate multiple signal metrics from the physiologic signals. The ambulatory medical device can determine a desired value for a device parameter, such as a timing parameter used for controlling the delivery of CRT pacing to various heart chambers, using information fusion of signal metrics that are selected based on one or more of a signal metric sensitivity to perturbations to the device parameter in response to a stimulation, a signal metric variability in response to a stimulation, or a covariability between two or more signal metrics in response to a stimulation. The ambulatory medical device can program a stimulation using the desired device parameter value, and deliver the programmed stimulation to one or more target sites to achieve desired therapeutic effects.

Abstract: In one example, a method of monitoring a sustained activity of a human or animal subject for the purpose of determining a risk group includes detecting a physical activity signal from the subject, determining a magnitude of the detected physical activity signal, initiating a timer in response to determining the magnitude of the physical activity signal exceeding an activity level threshold, triggering storing at least one value associated with the physical activity signal only when the magnitude of the physical activity signal exceeds the activity level threshold and the timer is greater than a duration threshold, and determining, using the processor circuit, an indication of the subject's cardiovascular disease based on the stored value.

Abstract: Devices and methods for improving device therapy such as cardiac resynchronization therapy (CRT) are described. An ambulatory medical device can receive one or more physiologic signals and generate multiple signal metrics from the physiologic signals. The ambulatory medical device can determine a desired value for a device parameter, such as a timing parameter used for controlling the delivery of CRT, using information fusion of signal metrics that are selected based on one or more of a signal metric sensitivity to perturbations to the device parameter, a signal metric variability, or a covariability between two or more signal metrics. The ambulatory medical device can program a stimulation using the desired device parameter value, and deliver the programmed stimulation to one or more target sites to achieve desired therapeutic effects.

Abstract: A CRM system enhances intracardiac electrogram-based arrhythmia detection using a wireless electrocardiogram (ECG), which is a signal sensed with implantable electrodes and approximating a surface ECG. In one embodiment, an intracardiac electrogram allows for detection of an arrhythmia, and the wireless ECG allows for classification of the detected arrhythmia by locating its origin. In another embodiment, the wireless ECG is sensed as a substitute signal for the intracardiac electrogram when the sensing of the intracardiac electrogram becomes unreliable. In another embodiment, a cardiac signal needed for a particular purpose is selected from one or more intracardiac electrograms and one or more wireless ECGs based on a desirable signal quality. In another embodiment, intracardiac electrogram-based arrhythmia detection and wireless ECG-based arrhythmia detection confirm with each other before indicating a detection of arrhythmia of a certain type.

Abstract: An apparatus comprises plurality of sensors and a processor. Each sensor provides a sensor signal that includes physiological information and at least one sensor is implantable. The processor includes a physiological change event detection module that detects a physiological change event from a sensor signal and produces an indication of occurrence of one or more detected physiological change events, and a heart failure (HF) detection module. The HF detection module determines, using a first rule, whether the detected physiological change event is indicative of a change in HF status of a subject, determines whether to override the first rule HF determination using a second rules, and declares whether the change in HF status occurred according to the first and second rules.

Abstract: Devices and methods for improving device therapy such as cardiac resynchronization therapy (CRT) by determining a desired value for a device parameter are described. An ambulatory medical device can be configured to detect a heart sound signal and generate one or more heart sound metrics, detect a characteristic indicative of cannon waves, and determine a desired value for a device parameter, such as a timing parameter which can be used to control the delivery of CRT pacing to various heart chambers. The desired device parameter value can be determined using the heart sound metrics and the characteristic indicative of the cannon waves. The ambulatory medical device can program stimulation using the desired device parameter value, and deliver the programmed stimulations to one or more target sites to achieve desired therapeutic effects.

Abstract: A hospitalization management system including a heart failure analyzer that receives diagnostic data including at least sensor data representative of one or more physiological signals sensed from a hospitalized patient using one or more sensors and assesses risk of rehospitalization for the patient using the diagnostic data. The outcome of the risk assessment is used during and following the patient's hospitalization for reducing the risk of rehospitalization.

Abstract: Devices and methods for differentially diagnosing between worsening heart failure (HF) and other diseases or medical conditions are described. A medical system can receive patient information including one or more physiologic signals, and detect a respective physiologic feature from each of the one or more received physiologic signals. The medical system can include a differential diagnosis circuit that generates one or more signal metrics, receive two or more candidate conditions associated with the change in patient physical or physiological status, and determine a respective diagnostic score for each of the candidate conditions. The diagnostic score can indicate likelihood the change in the patient physical or physiologic status being caused by the corresponding candidate condition. A user interface can be provided to generate a presentation of the detected physiologic features and the diagnostic scores associated with the candidate conditions.

Abstract: Stimulation energy can be provided to stimulate synchronous ventricular contractions. Interval information obtained from a cardiac electrical heart signal and a cardiac mechanical heart signal can be used to determine a right ventricular activation time. The interval information can provide a cardiac stimulation indication.

Abstract: An apparatus comprises plurality of sensors and a processor. Each sensor provides a sensor signal that includes physiological information and at least one sensor is implantable. The processor includes a physiological change event detection module that detects a physiological change event from a sensor signal and produces an indication of occurrence of one or more detected physiological change events, and a heart failure (HF) detection module. The HF detection module determines, using a first rule, whether the detected physiological change event is indicative of a change in HF status of a subject, determines whether to override the first rule HF determination using a second rules, and declares whether the change in HF status occurred according to the first and second rules.