Abstract: Systems and methods for detecting a physiological event or estimating a physiological parameter using ambulatory electrograms of a subject are discussed. An exemplary system includes a computing device that can receive ambulatory electrograms collected by an ambulatory medical device (AMD) associated with a subject, and apply the ambulatory electrograms to a trained machine learning model to estimate a physiological parameter or to detect a physiological event in the subject. The same or a different machine learning model can be trained to detect an operating status of the AMD using the ambulatory electrograms. The system comprises an output device to output the estimated physiological parameter, the detected physiological event, or the detected device operating status a user or a process such as to initiate or titrate a therapy.

Abstract: Systems and methods to predict a patient mortality risk are disclosed, including determining a risk value for a plurality of physiologic measures and determining a mortality risk metric indicative of a risk of patient mortality as a weighted combination of the plurality of physiologic measures having risk values satisfying a pre-determined condition.

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: Various embodiment disclosed herein include a method for monitoring serum potassium in a patient. The method can include gathering cardiac electrogram data from the patient using two or more electrodes, separating the cardiac electrogram data into discrete subunits including a T-wave, aligning T-waves to create aligned discrete subunits, averaging the aligned discrete subunits to generate an average T-wave for the cardiac electrogram data, and determining a serum potassium value using the average T-wave for the cardiac electrogram data and a predetermined model relating T-wave values with serum potassium magnitudes.

Abstract: Cardiac therapy devices in the form of pacemakers and/or defibrillators including one or more leads with electrodes implanted in a vein in a posterior position in combination with one or more leads with electrodes implanted in an anterior position. The posterior position may be chosen from one or more of the azygos, hemiazygos, accessory hemiazygos, or posterior intercostal veins. The anterior position may be chosen from the internal thoracic vein, an anterior intercostal vein, or an anterior subcutaneous location. In other examples, sensors are placed for use by a cardiac monitoring or therapy system in one or more of the internal thoracic vein, the azygos vein, the hemiazygos vein, the accessory hemiazygos vein, and/or an anterior or posterior intercostal vein.

Abstract: This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, to alternate first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, to receive information indicative of patient metabolic demand, and to determine an adjusted pacing-based hypertension therapy parameter using the received information indicative of patient metabolic demand, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay.

Abstract: This document discusses, among other things, systems and methods to receive physiologic information from a patient during different first and second pacing periods having respective, different first and second atrioventricular (AV) delays, determine first and second physiologic parameters using respective received physiologic information from the first and second pacing periods, and adjust the first AV delay using the determined first and second physiologic parameters, wherein the second AV delay is longer than the first AV delay.

Abstract: A system for dialysis is disclosed. An example peritoneal dialysis system includes a peritoneal dialysis machine including a pumping mechanism, and a sensor configured to measure a property of peritoneal dialysis fluid. The peritoneal dialysis system also includes a disposable cassette operable with the peritoneal dialysis machine. The disposable cassette includes a fluid source inlet for accepting fluid from a fluid source and a fluid flow path in fluid communication with the fluid source inlet. The fluid flow path includes a pump chamber operable with the pumping mechanism to pump fluid through the fluid flow path. The disposable cassette also includes a concentrate inlet for fluidly communicating concentrate to the fluid flow path, and a sensor chamber located along the fluid flow path and operable with the sensor. The sensor is configured to provide feedback to the peritoneal dialysis machine for mixing the concentrate for forming peritoneal dialysis fluid.

Abstract: This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, and alternate the first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay. Physiologic information can be received from the patient, and one of the first or second pacing period for delivery to the patient can be determined using the received physiologic information.

Abstract: Systems and methods for assessing hemodynamic status of a patient experiencing atrial tachyarrhythmia such as an atrial fibrillation (AF) episode are disclosed. A system can comprise an atrial tachyarrhythmia detection circuit configured to detect an AF episode, a hemodynamic sensor circuit configured to sense at least one hemodynamic signal, and a hemodynamic status analyzer circuit that can calculate one or more signal metrics using the sensed hemodynamic signal during the AF episode. The hemodynamic status analyzer circuit can categorize the hemodynamic status of the patient into one of two or more categorical hemodynamic status levels which indicate elevated hemodynamic impact of the detected AF episode. A user interface can provide to an end-user a presentation of the categorized hemodynamic status level during AF.

Abstract: This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, to alternate first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, and to determine an increased pacing rate for the first pacing waveform during the first pacing period using the first AV delay, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. A medical system includes an electrostimulation circuit that may generate His-bundle pacing (HBP) pulses for delivery at or near the His bundle. In response to the delivery of the HBP pulse, the system senses a near-field cardiac activity representative of excitation of a para-Hisian myocardial tissue, and a far-field cardiac activity representative of excitation of the His bundle and a ventricle. The system classifies a tissue response to HBP into one of a plurality of capture types based on the sensed near-field and far-field cardiac activities. The system includes a control circuit to adjust one or more stimulation parameters based on the classified capture type. The electrostimulation circuit generates and delivers the HBP pulses according to the adjusted stimulation parameters to excite the His bundle.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. A medical system includes electrostimulation circuit that may generate His-bundle pacing (HBP) pulses for delivery at or near the His bundle. A capture verification circuit may detect, from a far-field signal representing ventricular response to the HBP pulses, a His-bundle response representative of excitation of the His bundle directly resulting from the HBP pulses, and a myocardial response representative of excitation of the myocardium directly resulting from the HBP pulses. A control circuit may adjust one or more stimulation parameters based on the His-bundle response and myocardial response. The electrostimulation circuit may generate and deliver the HBP pulses according to the adjusted stimulation parameters to excite the His bundle.

Abstract: Embodiments herein include systems and methods for detecting, predicting and/or assessing acute kidney injury. In an embodiment, a monitoring system to detect acute kidney injury is included. The monitoring system can include a sensor circuit configured to collect renal data including at least one of systemic renal data, direct renal data, urinary tract data, and renal-relevant extracorporeal data. The monitoring system can also include a memory circuit to store collected renal data, an evaluation circuit to assess renal status, and a telemetry circuit. The evaluation circuit can determine whether acute kidney injury has occurred or is likely to occur by comparing the renal data to at least one of threshold values, personal historical values, patient population values and patterns indicative of acute kidney injury. The evaluation circuit can initiate a warning notification if acute kidney injury has occurred or is likely to occur. Other embodiments are also included herein.

Abstract: Intermittent delivery of ventricular pacing pulses synchronized to occur during an atrial diastole time period can be used to provide atrial stretch therapy and augment the production and release of atrial natriuretic hormone.

Abstract: Cardiac therapy devices in the form of pacemakers and/or defibrillators including one or more leads with electrodes implanted in a vein in a posterior position in combination with one or more leads with electrodes implanted in an anterior position. The posterior position may be chosen from one or more of the azygos, hemiazygos, accessory hemiazygos, or posterior intercostal veins. The anterior position may be chosen from the internal thoracic vein, an anterior intercostal vein, or an anterior subcutaneous location. In other examples, sensors are placed for use by a cardiac monitoring or therapy system in one or more of the internal thoracic vein, the azygos vein, the hemiazygos vein, the accessory hemiazygos vein, and/or an anterior or posterior intercostal vein.

Abstract: Cardiac therapy devices in the form of pacemakers and/or defibrillators including one or more leads with electrodes implanted in a vein in a posterior position in combination with one or more leads with electrodes implanted in an anterior position. The posterior position may be chosen from one or more of the azygos, hemiazygos, accessory hemiazygos, or posterior intercostal veins. The anterior position may be chosen from the internal thoracic vein, an anterior intercostal vein, or an anterior subcutaneous location. In other examples, sensors are placed for use by a cardiac monitoring or therapy system in one or more of the internal thoracic vein, the azygos vein, the hemiazygos vein, the accessory hemiazygos vein, and/or an anterior or posterior intercostal vein.

Abstract: An apparatus comprises plurality of physiologic sensors and a processor circuit. The sensors provide sensor signals having physiological information and include a heart sound sensor and an impedance sensor. The processor circuit includes a volume index module configured to determine a value of at least one heart sound parameter using the heart sound signal and determine a value of at least one physiological impedance parameter value using the impedance signal, calculate a volume index representative of fluid volume status of the subject using the at least one heart sound parameter value and the at least one physiological impedance parameter value, compare a determined metric of the calculated volume index to one or more high threshold metric values and one or more low threshold metric values, and generate an indication of a fluid volume status of the subject according to the comparison.

Abstract: Various embodiment disclosed herein include a method for monitoring serum potassium in a patient. The method can include gathering cardiac electrogram data from the patient using two or more electrodes, separating the cardiac electrogram data into discrete subunits including a T-wave, aligning T-waves to create aligned discrete subunits, averaging the aligned discrete subunits to generate an average T-wave for the cardiac electrogram data, and determining a serum potassium value using the average T-wave for the cardiac electrogram data and a predetermined model relating T-wave values with serum potassium magnitudes.

Abstract: An apparatus comprises a stimulus circuit configured to deliver electrical pacing therapy to a subject when operatively coupled to a plurality of electrodes, a heart sound sensing circuit configured to produce a sensed heart sound signal representative of mechanical cardiac activity, a control circuit operatively coupled to the stimulus circuit and configured to vary a paced heart rate of the subject according to a specified paced heart rate protocol, and a signal processing circuit. The signal processing circuit is configured to obtain measures of a heart sound parameter as a function of heart rate using the sensed heart sound signal and determine a critical heart rate for the subject using the obtained measures of the heart sound parameter.