Abstract: The health state of a subject is automatically evaluated or predicted using at least one implantable device. In varying examples, the health state is determined by sensing or receiving information about at least one physiological process having a circadian rhythm whose presence, absence, or baseline change is associated with impending disease, and comparing such rhythm to baseline circadian rhythm prediction criteria. Other chronobiological rhythms beside circadian may also be used. The baseline prediction criteria may be derived using one or more past physiological process observation of the subject or population of subjects in a non-disease health state. The prediction processing may be performed by the at least one implantable device or by an external device in communication with the implantable device. Systems and methods for invoking a therapy in response to the health state, such as to prevent or minimize the consequences of predicted impending heart failure, are also discussed.

Abstract: Various system embodiments comprise a stimulator adapted to deliver a stimulation signal for a heart failure therapy, a number of sensors adapted to provide at least a first measurement of a heart failure status and a second measurement of the heart failure status, and a controller. The controller is connected to the stimulator and to the number of sensors. The controller is adapted to use the first and second measurements to create a heart failure status index, and control the stimulator to modulate the signal using the index. Other aspects and embodiments are provided herein.

Abstract: The health state of a subject is automatically evaluated or predicted using at least one implantable device. In varying examples, the health state is determined by sensing or receiving information about at least one physiological process having a circadian rhythm whose presence, absence, or baseline change is associated with impending disease, and comparing such rhythm to baseline circadian rhythm prediction criteria. Other chronobiological rhythms beside circadian may also be used. The baseline prediction criteria may be derived using one or more past physiological process observation of the subject or population of subjects in a non-disease health state. The prediction processing may be performed by the at least one implantable device or by an external device in communication with the implantable device. Systems and methods for invoking a therapy in response to the health state, such as to prevent or minimize the consequences of predicted impending heart failure, are also discussed.

Abstract: Various system embodiments comprise a stimulator adapted to deliver a stimulation signal for a heart failure therapy, a number of sensors adapted to provide at least a first measurement of a heart failure status and a second measurement of the heart failure status, and a controller. The controller is connected to the stimulator and to the number of sensors. The controller is adapted to use the first and second measurements to create a heart failure status index, and control the stimulator to modulate the signal using the index. Other aspects and embodiments are provided herein.

Abstract: A method embodiment comprises generating a neural stimulation signal for a neural stimulation therapy. The signal is generated during a duty cycle of a stimulation period to provide the neural stimulation therapy with an intensity at a therapy level for a portion of the duty cycle. In various embodiments, a ramp up protocol is implemented to begin the duty cycle, a ramp down protocol is implemented to end the duty cycle, or both the ramp up protocol and the ramp down protocol are implemented. The ramp up protocol includes ramping up the intensity from a non-zero first subthreshold level for the neural stimulation therapy at the beginning of the duty cycle to the therapy level. The ramp down protocol includes ramping down the intensity from the therapy intensity level to a non-zero second subthreshold level for the neural stimulation therapy at the end of the duty cycle.

Abstract: A medical device is disclosed for implantation on an epicardial surface of the heart. The device has a transmural member providing optimal electrode locations for various therapies. The hemodynamically optimal therapy is guided by sensed left ventricular pressure and electrical activity. The device may be used alone or with a companion implanted cardiac rhythm management device.

Abstract: An implantable cardiac rhythm management (CRM) device delivers a chronic therapy while detecting an ischemic state. When the ischemic state indicates the occurrence of an ischemic event, the implantable CRM device delivers a post-ischemia therapy. The post-ischemia therapy and the chronic therapy are adjusted using feedback control with the ischemic state and parameters indicative of the effectiveness of the post-ischemic therapy and the effectiveness of the chronic therapy as inputs.

Abstract: An implantable device and method for monitoring S1 heart sounds with a remotely located accelerometer. The device includes a transducer that converts heart sounds into an electrical signal. A control circuit is coupled to the transducer. The control circuit is configured to receive the electrical signal, identify an S1 heart sound, and to convert the S1 heart sound into electrical information. The control circuit also generates morphological data from the electrical information. The morphological data relates to a hemodynamic metric, such as left ventricular contractility. A housing may enclose the control circuit. The housing defines a volume coextensive with an outer surface of the housing. The transducer is in or on the volume defined by the housing.

Abstract: Described herein are methods and devices that utilize electrical neural stimulation to treat heart failure by modulating a patient's autonomic balance in a manner that inhibits sympathetic activity and/or augments parasympathetic activity. Because other therapies for treating heart failure may also affect a patient's autonomic balance, a device for delivering neural stimulation is configured to appropriately titrate such therapy in either an open-loop or closed-loop fashion.

Abstract: A method embodiment comprises generating a neural stimulation signal for a neural stimulation therapy. The signal is generated during a duty cycle of a stimulation period to provide the neural stimulation therapy with an intensity at a therapy level for a portion of the duty cycle. In various embodiments, a ramp up protocol is implemented to begin the duty cycle, a ramp down protocol is implemented to end the duty cycle, or both the ramp up protocol and the ramp down protocol are implemented. The ramp up protocol includes ramping up the intensity from a non-zero first subthreshold level for the neural stimulation therapy at the beginning of the duty cycle to the therapy level. The ramp down protocol includes ramping down the intensity from the therapy intensity level to a non-zero second subthreshold level for the neural stimulation therapy at the end of the duty cycle.

Abstract: Described herein are methods and devices that utilize electrical neural stimulation to treat heart failure by modulating a patient's autonomic balance in a manner that inhibits sympathetic activity and/or augments parasympathetic activity. Because other therapies for treating heart failure may also affect a patient's autonomic balance, a device for delivering neural stimulation is configured to appropriately titrate such therapy in either an open-loop or closed-loop fashion.

Abstract: A system or method including a device configured to measure at least one pharmacological effect of a drug on a patient. The measured pharmacological effect is compared to an expected pharmacodynamic model. The system can allow for real-time monitoring of positive and side-effects of drugs as well as drug resistance to optimize individual therapy. The system can also enable patient compliance monitoring.

Abstract: A system comprising an implantable medical device (IMD) includes an implantable heart sound sensor to produce an electrical signal representative of at least one heart sound. The heart sound is associated with mechanical activity of a patient's heart. Additionally, the IMD includes a heart sound sensor interface circuit coupled to the heart sound sensor to produce a heart sound signal, and a signal analyzer circuit coupled to the heart sound sensor interface circuit. The signal analyzer circuit measures a baseline heart sound signal, and deems that an ischemic event has occurred using, among other things, a measured subsequent change in the heart sound signal from the established baseline heart sound signal.

Abstract: In a method for determining a cardiac condition, a sensed physiologic signal for a period of time including multiple cardiac cycles is received. Using the received physiologic data, a heart beat frequency to be used as a reference frequency is determined. A plurality of harmonics of the received physiologic signal is extracted based on the reference frequency, wherein the harmonics correspond to a plurality of alternans frequencies. Amplitudes of at least some of the extracted harmonics are determined, and are used to determine an alternans indicator value.

Abstract: The health state of a subject is automatically evaluated or predicted using at least one implantable device. In varying examples, the health state is determined by sensing or receiving information about at least one physiological process having a circadian rhythm whose presence, absence, or baseline change is associated with impending disease, and comparing such rhythm to baseline circadian rhythm prediction criteria. Other chronobiological rhythms beside circadian may also be used. The baseline prediction criteria may be derived using one or more past physiological process observation of the subject or population of subjects in a non-disease health state. The prediction processing may be performed by the at least one implantable device or by an external device in communication with the implantable device. Systems and methods for invoking a therapy in response to the health state, such as to prevent or minimize the consequences of predicted impending heart failure, are also discussed.

Abstract: Various system embodiments comprise a stimulator adapted to deliver a stimulation signal for a heart failure therapy, a number of sensors adapted to provide at least a first measurement of a heart failure status and a second measurement of the heart failure status, and a controller. The controller is connected to the stimulator and to the number of sensors. The controller is adapted to use the first and second measurements to create a heart failure status index, and control the stimulator to modulate the signal using the index. Other aspects and embodiments are provided herein.

Abstract: A system receives signals indicative of cardiopulmonary conditions sensed by a plurality of sensors and provides for monitoring and automated differential diagnosis of the cardiopulmonary conditions based on the signals. Cardiogenic pulmonary edema is detected based on one or more signals sensed by implantable sensors. If the cardiogenic pulmonary edema is not detected, obstructive pulmonary disease and restrictive pulmonary disease are each detected based on a forced vital capacity (FVC) parameter and a forced expiratory volume (FEV) parameter measured from a respiratory signal sensed by an implantable or non-implantable sensor. In one embodiment, an implantable medical device senses signals indicative of the cardiopulmonary conditions, and an external system detects the cardiopulmonary conditions based on these signals by executing an automatic detection algorithm.

Abstract: A system comprising an implantable medical device (IMD) includes an implantable heart sound sensor to produce an electrical signal representative of at least one heart sound. The heart sound is associated with mechanical activity of a patient's heart. Additionally, the IMD includes a heart sound sensor interface circuit coupled to the heart sound sensor to produce a heart sound signal, and a signal analyzer circuit coupled to the heart sound sensor interface circuit. The signal analyzer circuit measures a baseline heart sound signal, and deems that an ischemic event has occurred using, among other things, a measured subsequent change in the heart sound signal from the established baseline heart sound signal.

Abstract: An implantable device and method for monitoring S1 heart sounds with a remotely located accelerometer. The device includes a transducer that converts heart sounds into an electrical signal. A control circuit is coupled to the transducer. The control circuit is configured to receive the electrical signal, identify an S1 heart sound, and to convert the S1 heart sound into electrical information. The control circuit also generates morphological data from the electrical information. The morphological data relates to a hemodynamic metric, such as left ventricular contractility. A housing may enclose the control circuit. The housing defines a volume coextensive with an outer surface of the housing. The transducer is in or on the volume defined by the housing.

Abstract: Various system embodiments comprise a stimulator adapted to deliver a stimulation signal for a heart failure therapy, a number of sensors adapted to provide at least a first measurement of a heart failure status and a second measurement of the heart failure status, and a controller. The controller is connected to the stimulator and to the number of sensors. The controller is adapted to use the first and second measurements to create a heart failure status index, and control the stimulator to modulate the signal using the index. Other aspects and embodiments are provided herein.