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: The technology herein relates to a troubleshooting system for remote patient monitoring. A plurality of triggering conditions defines a data transmission error between a sensor and a remote location. A data transmission log is configured to receive characterization data defining each successful data transmission between a communicator and the remote location. An input user interface is configured to receive input from a user and an output user interface is configured to provide notification to a user. Processing circuitry is in communication with the input interface and the output interface, where the processing circuitry is configured to compare each of the triggering conditions to the characterization data to identify a data transmission error. Upon identification of the data transmission error, the processing circuitry causes the output interface to present a query to the user.

Abstract: Systems and methods for monitoring patients for risk of worsening heart failure (WHF) are discussed. A patient management system includes a receiver to receive patient respiration measurement. A respiratory pattern analyzer circuit measures respiratory pattern indicative of rapid-shallow breathing pattern from the received respiration measurement, and determine a respiratory pattern variability indicator. A risk analyzer circuit determines patient WHF risk using the respiratory pattern variability indicator. The system may use the WHF risk to guide WHF event detection, or to deliver or adjust a heart failure therapy.

Abstract: Systems and methods for detecting cardiac conditions such as events indicative of worsening heart failure are described. A system can include a sensor circuit to sense a physiological signal, transform one or more first signal portions of the physiological signal into one or more baseline values, and transform one or more second signal portions of the physiological signal into short-term values associated with respective timing information. The system can generate a cardiac condition indicator using a weighted combination of relative difference between the one or more short-term values and the one or more baseline values. The weighting can include one or more weight factors determined according to the timings of the one or more second signal portions. The system can output an indication of a progression over time of the cardiac condition indicator, or deliver therapy according to the cardiac condition indicator.

Abstract: A delivery and deployment device may include a handle assembly and a shaft extending distally from the handle assembly. A device containment housing may be coupled to a distal region of the shaft and may extend distally therefrom. The distal containment housing may be configured to accommodate at least a portion of the IMD therein. The IMD may, for example, be a leadless pacemaker, a lead, a neurostimulation device, a sensor or any other suitable IMD. A plurality of electrodes may be distributed about an exterior surface of the device containment housing such that at least some of the plurality of electrodes may be positioned to test a potential IMD deployment location before deploying the IMD.

Abstract: Systems and methods for detecting worsening cardiac conditions such as worsening heart failure events are described. A system may include sensor circuits to sense physiological signals and signal processors to generate from the physiological signals first and second signal metrics. The system may include a risk stratifier circuit to produce a cardiac risk indication. The system may use at least the first signal metric to generate a primary detection indication, and use at least the second signal metric and the risk indication to generate a secondary detection indication. The risk indication may be used to modulate the second signal metric. A detector circuit may detect the worsening cardiac event using the primary and secondary detection indications.

Abstract: Systems and methods for detecting worsening cardiac conditions such as worsening heart failure events are described. A system may include sensor circuits to sense physiological signals and signal processors to generate from the physiological signals first and second signal metrics. The system may include a risk stratifier circuit to produce a cardiac risk indication. The system may use at least the first signal metric to generate a primary detection indication, and use at least the second signal metric and the risk indication to generate a secondary detection indication. The risk indication may be used to modulate the second signal metric. A detector circuit may detect the worsening cardiac event using the primary and secondary detection indications.

Abstract: An implantable or other ambulatory medical apparatus comprises a posture sensing circuit, a physiologic sensing circuit that senses a time varying physiologic signal, and a processor circuit. The processor circuit includes a posture calculation circuit and a measurement circuit. The posture calculation circuit determines a posture of the subject using posture data obtained using the posture signal and determines when the posture of the subject is steady state. The measurement circuit derives a physiologic measurement using physiologic data extracted from the physiologic signal during at least one time period when posture is determined to be steady state and provides the physiologic measurement to at least one of a user and a process in association with the determined steady state posture.

Abstract: Devices and methods for detecting an event using a variable threshold. A patient monitoring system can receive physiologic information and compare the information to an onset threshold. When the onset threshold is exceeded, the system shifts to a reset threshold that is different than the onset threshold. When the reset threshold is crossed, the system shifts back to the onset threshold.

Abstract: Systems and methods for monitoring patients with a chronic disease are described. A patient management system may sense physiological signals from a patient using one or more implantable or other ambulatory sensors, and generate from the physiological signals a chronobiological rhythm indicator (CRI) such as indicating a circadian rhythm. A reference CRI associated with a prior hospital admission event of the patient may be provided to the patient management system, which compares the CRI to the reference CRI and generates a readmission risk score indicating the patient's risk of subsequent hospital readmission due to a worsened condition of the chronic disease. The readmission risk score may be provided to a user or a process, or used to initiate or adjust a therapy delivered to the patient.

Abstract: Systems and methods for managing machine-generated alerts of a medical event such as worsening heart failure (WHF) are described. A patient management system includes a patient database of information about a correspondence between a plurality of alert thresholds (ATHs) and corresponding clinical outcome indicators (COIs) for a plurality of patients. A control circuit can query the patient database for a matching patient that meets specific query criteria compared to a target patient, retrieve an ATH-COI correspondence associated with the matching patient, and determine the alert threshold using a user input of a COI and the retrieved ATH-COI correspondence. A medical event detector detects the medical event using physiological signals sensed from the target patient and the determined alert threshold.

Abstract: Systems and methods for monitoring patient vasoactivity are discussed. An exemplary patient monitor system includes a sensor circuit configured to generate a heart sound (HS) metric using a HS signal sensed from a patient, and a vasoactivity monitor configured to monitor vasoactivity, such as degree of vasoconstriction or vasodilation, using the HS metric. The system can provide the monitored vasoactivity to a user to alert patient hemodynamic responses to vasoactive drugs, or initiate or adjust a vasoactive therapy according to the vasoactivity. The system may use the monitored vasoactivity to detect a medical condition such as worsening heart failure, pulmonary edema, or syncope.

Abstract: An implantable medical device (IMD) that includes a housing, a first electrode secured relative to the housing, a second electrode secured relative to the housing, and a gyroscope secured relative to the housing. The IMD may include circuitry in the housing in communication with the first electrode, the second electrode, and the gyroscope. The circuitry may be configured to determine and store a plurality of torsion data measurements, from which a representation of a twist profile may be determined.

Abstract: Systems and methods for monitoring patients with a chronic disease are described. A patient management system may sense physiological signals from a patient using one or more implantable or other ambulatory sensors, and generate from the physiological signals a chronobiological rhythm indicator (CRI) such as indicating a circadian rhythm. A reference CRI associated with a prior hospital admission event of the patient may be provided to the patient management system, which compares the CRI to the reference CRI and generates a readmission risk score indicating the patient's risk of subsequent hospital readmission due to a worsened condition of the chronic disease. The readmission risk score may be provided to a user or a process, or used to initiate or adjust a therapy delivered to the patient.

Abstract: This document discusses, among other things, systems and methods to receive physiologic information from a patient using an ambulatory medical device, and to determine an indication of cardiotoxicity using the received physiologic information.

Abstract: Devices and methods for detecting an event using a variable threshold. A patient monitoring system can receive physiologic information and compare the information to an onset threshold. When the onset threshold is exceeded, the system shifts to a reset threshold that is different than the onset threshold. When the reset threshold is crossed, the system shifts back to the onset threshold.

Abstract: Methods, systems and devices for providing cardiac resynchronization therapy (CRT) to a patient using a leadless cardiac pacemaker (LCP) and an extracardiac device (ED). The system is configured to identify atrial events to use as timing markers for the LCP to deliver CRT, and further to determine whether the timing markers are incorrectly sensed and to make adjustment or call for re-initialization as needed.

Abstract: Systems and methods for detecting cardiac conditions such as events indicative of worsening of heart failure (HF) are described. A system can receive a physiological signal from a patient, transform one or more first portions of the physiological signal into respective one or more baseline statistical values, transform one or more second portions of the physiological signal into one or more historical extreme values, and generate one or more reference values of a physiologic parameter using the baseline statistical values and the historical extreme values. The system can transform one or more third signal portions of the physiological signal into respective one or more short-term values, and produce a cardiac condition indicator using a combination of relative differences between the short-term values and the corresponding reference values. The system can output the cardiac condition indicator, or deliver therapy according to the cardiac condition indicator.

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: 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