Abstract: Apparatus using one or more modes of statistical analysis with one or more monitored parameters of a patient's heart to identify and/or assess arrhythmias. Through use of the one or more modes of statistical analysis, a medical professional can be aided during evaluation of patient data for diagnosis of the patient. At least one of the monitored parameters may include one or more values used representatively for storage intervals of a selected length. As such, for each storage interval, a value may be determined for the one monitored parameter occurring at an upper percentile and a lower percentile. In addition, a median value may be determined for the one monitored parameter for each storage interval. Over a plurality of the storage intervals, these determined values can be used in one or more modes of statistical analysis to better identify and assess the arrhythmias.

Abstract: A method includes controlling a cardiac pacing rate of an implantable medical device to control a heart rate of a patient and detecting inhalation and exhalation of the patient. The method further includes determining that the patient is in a resting state, and, in response to determining that the patient is in the resting state, incrementally increasing the pacing rate while exhalation of the patient is detected and incrementally decreasing the pacing rate while inhalation of the patient is detected.

Abstract: A method includes controlling a cardiac pacing rate of an implantable medical device (IMD) to control a heart rate of a patient and determining that the patient is in a resting state. The method further includes modifying the pacing rate of the IMD for N cardiac cycles in response to determining that the patient is in the resting state. N is an integer greater than 1. Modifying the pacing rate includes incrementally increasing the pacing rate for a first portion of the N cardiac cycles, and incrementally decreasing the pacing rate for a second portion of the N cardiac cycles.

Abstract: Techniques for controlling therapy based on a physiological parameter indicative of ventricular filling pressure, such as various cardiovascular pressures, are described. One or more values of the physiological parameter that are collected during nighttime, or while the patient is otherwise asleep, inactive, or within a recumbent position, may be compared to one or more values of the physiological parameter collected during daytime, or while the patient is otherwise awake, active and/or upright. A therapy, such as for treating physiological factors that may lead to worsening HF, may be initiated or adjusted based on the comparison, e.g., if the nighttime values exceed the daytime values.

Abstract: An implantable medical device system including a physiological sensor detects signal artifact in a signal waveform acquired by the sensor. Features of individual waveforms in the sensor signal are extracted. Sample waveforms are classified by expert observation into at least two classes including an artifact class. A distribution range for each of the extracted features from the sample waveforms is determined for each of the classes. Waveform classification criteria are established in response to the determined distribution ranges.

Abstract: A method of determining a respiration parameter in a medical device in which pressure signals are sensed to generate corresponding sample points, and a breath detection threshold is continuously adjusted in response to the generated sample points to generate a current adjusted breath detection threshold. A current generated sample point is compared to the current adjusted breath detection threshold, and the continuous adjusting of the breath detection threshold is suspended and the breath detection threshold is equal to the most current adjusted breath detection threshold generated prior to the suspending in response to the comparing. A next sample point, generated subsequent to the suspending, is compared to the set breath detection threshold, and the respiration parameter is determined in response to the comparing of a next sample point to the set breath detection threshold.

Abstract: A method includes controlling a cardiac pacing rate of an implantable medical device to control a heart rate of a patient and detecting inhalation and exhalation of the patient. The method further includes determining that the patient is in a resting state, and, in response to determining that the patient is in the resting state, incrementally increasing the pacing rate while exhalation of the patient is detected and incrementally decreasing the pacing rate while inhalation of the patient is detected.

Abstract: A method includes controlling a cardiac pacing rate of an implantable medical device (IMD) to control a heart rate of a patient and determining that the patient is in a resting state. The method further includes modifying the pacing rate of the IMD for N cardiac cycles in response to determining that the patient is in the resting state. N is an integer greater than 1. Modifying the pacing rate includes incrementally increasing the pacing rate for a first portion of the N cardiac cycles, and incrementally decreasing the pacing rate for a second portion of the N cardiac cycles.

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: A system and method are provided for determining an index of autonomic nervous system (ANS) or sympathetic nervous system (SNS) activity for use in patient monitoring or therapy delivery control. An ANS or SNS index is calculated as a function of multiple monitored physiological variables that strongly correlate to changes in autonomic or sympathetic tone. These ANS-influenced variables are derived from selected hemodynamic and/or electrical signals and may include variables relating to any of: the maximum rate of pressure rise (dP/dtmax), the maximum rate of pressure decline (dP/dtmin), pulse pressure (PP), pre-ejection time interval (PEI) and/or systolic time interval (STI), heart rate (HR), heart rate variability (HRV), and baro-reflex gain. Changes in the ANS or SNS index may be used to automatically adjust a device delivered therapy.

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 for determining a respiratory effort having a pressure sensor to sense pressure signals, a housing having system components positioned therein, and a microprocessor positioned within the housing, wherein the microprocessor detects an inspiration and an expiration in response to the pressure signals, detects a breath in response to the detected inspiration and the detected expiration, and determines the respiratory effort in response to the detected breath.

Abstract: A system and method of determining hemodynamic parameters uses sensed ventricular blood pressure during a portion of ventricular pressure waveform following peak pressure. An estimated arterial diastolic pressure is based upon an amplitude of the sensed ventricular pressure corresponding to a time at which a first derivative of ventricular pressure as a function of time is at a minimum (dP/dtmin). Fill parameters such as isovolumetric relaxation constant, ventricular suction pressure, atrial kick pressure, and transvalve pressure gradient are derived from measured pressures representing minimum ventricular pressure, ventricular diastolic pressure, and diastasis pressure.

Abstract: A method of determining respiratory effort in a medical device in which pressure signals are sensed to generate corresponding sample points, an inspiration and an expiration are detected in response to the sensed pressure signals, a breath is detected in response to the detected inspiration and the detected expiration, and the respiratory effort is determined in response to the detected breath.

Abstract: Continuous remote monitoring of patients based on data obtained from an implantable hemodynamic monitor provides an interactive patient management system. Using network systems, patients are remotely monitored to continuously diagnose and treat heart-failure conditions. A screen displayable summary provides continuous feedback and information to physicians, patients and authorized third parties. The quick look summary includes various sites and presentation tailored to match the patients' and physicians' needs. The quick look summary further includes intelligent features that understand and retain the user's interests, preferences and use patterns. Patients, physicians and other caregivers are seamlessly connected to monitor and serve the chronic needs of heart-failure patients in a reliable and economic manner.

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.

Abstract: A medical device and method for determining baroreflex sensitivity (BRS) based on one or more respiration cycles. The BRS determination may be performed continuously based on measurements of heart rate, blood pressure, and respiration cycles.

Abstract: Continuous remote monitoring of patients based on data obtained from an implantable hemodynamic monitor provides an interactive patient management system. Using network systems, patients are remotely monitored to continuously diagnose and treat heart-failure conditions. A screen displayable summary provides continuous feedback and information to physicians, patients and authorized third parties. The quick look summary includes various sites and presentation tailored to match the patients' and physicians' needs. The quick look summary further includes intelligent features that understand and retain the user's interests, preferences and use patterns. Patients, physicians and other caregivers are seamlessly connected to monitor and serve the chronic needs of heart-failure patients in a reliable and economic manner.

Abstract: Heart failure decompensation is detected by sensing at least one physiological signal. Values of at least two different heart failure variables are derived using one or more physiological signals and a threshold for the first heart failure variable is adjusted in response to the value of the second heart failure variable. The value of the first heart failure variable is compared to first threshold for detecting a heart failure condition.

Abstract: A system and method for filtering a pressure signal in a medical device in which a sensor terminal senses the pressure signal, an electrode terminal receives cardiac electrical signals, a signal filtering system filters the sensed pressure signal in response to a determined heart rate to generate a heart-rate dependent frequency response, and a microprocessor derives a respiration signal in response to the heart rate dependent frequency response, and determines metrics of hemodynamic function in response to the derived respiration signal.