Systems and methods for dynamic control of heart failure therapy

Abstract

Systems and methods for monitoring and treating patients with heart failure (HF) are discussed. The system may sense cardiac signals, and receives information about patient physiological or functional conditions. A stimulation parameter table that includes recommended values of atrioventricular delay (AVD) or other timing parameters may be created at a multitude of patient physiological or functional conditions. The system may periodically reassess patient physiological or functional conditions. A therapy programmer circuit may dynamically switch between left ventricular-only pacing and biventricular pacing, or switch between single site pacing and multisite pacing based on the patient condition. The therapy programmer circuit may adjust AVD and other timing parameters using the cardiac signal input and the stored stimulation parameter table. A HF therapy may be delivered according to the determined stimulation site, stimulation mode, and the stimulation timing.

1 . A system, comprising:
 a memory configured to store a plurality sets of stimulation parameters for different postures, each set of stimulation parameters corresponding to a plurality of stored heart rates or heart rate ranges with respect to a corresponding stored posture; and   a stimulation control circuit configured to:
 receive a detected heart rate and posture information of a patient; 
 select, from the plurality of stored sets of stimulation parameters in the memory, a stimulation parameter in accordance with the detected heart rate and the received posture information of the patient; 
 control delivery of cardiac stimulation according to the selected stimulation parameter; and 
 update at least a portion of the plurality of stored sets of stimulation parameters using an atrioventricular conduction characteristic of the patient. 
   
     
     
         2 . The system of  claim 1 , wherein the plurality of stored sets of stimulation parameters include at least one of a first set of stimulation parameters for a supine posture, a second set of stimulation parameters for a sitting posture, or a third set of stimulation parameters for a standing posture. 
     
     
         3 . The system of  claim 1 , wherein the stimulation control circuit is configured to receive the posture information from a posture sensor associated with the patient. 
     
     
         4 . The system of  claim 1 , wherein the plurality of stored sets of stimulation parameters include stimulation timing parameters including atrioventricular delay values, or interventricular delay values. 
     
     
         5 . The system of  claim 1 , wherein the plurality of stored sets of stimulation parameters include stimulation site parameters including at least one of: an indication of left ventricular-only pacing; an indication of biventricular pacing; an indication of single site left-ventricular pacing; or an indication of multisite left-ventricular pacing. 
     
     
         6 . The system of  claim 1 , wherein the plurality of stored sets of stimulation parameters further correspond to stored atrial sensed (AS) events and atrial paced (AP) events, and the stimulation control circuit is configured to select the stimulation parameter further according to a detected AS event or a detected AP event. 
     
     
         7 . The system of  claim 1 , wherein the stimulation control circuit is configured to store in the memory a stimulation parameter table that includes the plurality of stored sets of stimulation parameters respectively determined for the different postures and corresponding to the plurality of stored heart rates or heart rate ranges. 
     
     
         8 . The system of  claim 1 , wherein the stimulation control circuit is configured to update at least the portion of the plurality of stored sets of stimulation parameters further using a cardiac or hemodynamic response of the patient to cardiac stimulation. 
     
     
         9 . A system, comprising:
 a memory configured to store a plurality sets of stimulation parameters for different times of a day, each set of stimulation parameters corresponding to a plurality of stored heart rates or heart rate ranges with respect to a corresponding stored time of the day; and   a stimulation control circuit configured to:
 receive a detected heart rate and time of a day information of a patient; 
 select, from the plurality of stored sets of stimulation parameters in the memory, a stimulation parameter in accordance with the detected heart rate and the received time of the day information of the patient; 
 control delivery of cardiac stimulation according to the stimulation parameter; and 
 update at least a portion of the plurality of stored sets of stimulation parameters using an atrioventricular conduction characteristic of the patient. 
   
     
     
         10 . The system of  claim 9 , wherein the plurality of stored sets of stimulation parameters include at least one of a first set of stimulation parameters for daytime of the day, a second set of stimulation parameters for nighttime of the day, or a third set of stimulation parameters for a pre-determined time period in the day. 
     
     
         11 . The system of  claim 9 , wherein the plurality of stored sets of stimulation parameters include stimulation timing parameters including atrioventricular delay values or interventricular delay values. 
     
     
         12 . The system of  claim 9 , wherein the plurality of stored sets of stimulation parameters include stimulation site parameters including at least one of: an indication of left ventricular-only pacing; an indication of biventricular pacing; an indication of single site left-ventricular pacing; or an indication of multisite left-ventricular pacing. 
     
     
         13 . The system of  claim 9 , wherein the plurality of stored sets of stimulation parameters further correspond to stored atrial sensed (AS) events and atrial paced (AP) events, and the stimulation control circuit is configured to select the stimulation parameter further according to a detected AS event or a detected AP event. 
     
     
         14 . The system of  claim 9 , wherein the stimulation control circuit is configured to store in the memory a stimulation parameter table that includes the plurality of stored sets of stimulation parameters respectively determined for the different times of the day and corresponding to the plurality of stored heart rates or heart rate ranges. 
     
     
         15 . The system of  claim 9 , wherein the stimulation control circuit is configured to update at least the portion of the plurality of stored sets of stimulation parameters further using a cardiac or hemodynamic response of the patient to cardiac stimulation. 
     
     
         16 . A method of operating a system to control cardiac stimulation, the method comprising:
 storing in a memory a plurality sets of stimulation parameters for different postures, each set of stimulation parameters corresponding to a plurality of stored heart rates or heart rate ranges with respect to a corresponding stored posture;   receiving a detected heart rate and posture information of a patient;   selecting, from the plurality of sets of stimulation parameters stored in the memory, a stimulation parameter in accordance with the detected heart rate and the received posture information of the patient using a stimulation control circuit;   delivering cardiac stimulation in accordance with the selected stimulation parameter; and   updating at least a portion of the plurality of stored sets of stimulation parameters using an atrioventricular conduction characteristic of the patient.   
     
     
         17 . The method of  claim 16 , wherein the plurality of stored sets of stimulation parameters include at least one of a first set of stimulation parameters for a supine posture, a second set of stimulation parameters for a sitting posture, or a third set of stimulation parameters for a standing posture. 
     
     
         18 . The method of  claim 16 , wherein the plurality of stored sets of stimulation parameters include stimulation timing parameters including atrioventricular delay values, or interventricular delay values. 
     
     
         19 . The method of  claim 16 , wherein the plurality of stored sets of stimulation parameters include stimulation site parameters including at least one of: an indication of left ventricular-only pacing; an indication of biventricular pacing; an indication of single site left-ventricular pacing; or an indication of multisite left-ventricular pacing. 
     
     
         20 . The method of  claim 16 , wherein the plurality of stored sets of stimulation parameters further correspond to stored atrial sensed (AS) events and atrial paced (AP) events,
 wherein the selecting of the stimulation parameter is further in accordance with a detected AS event or a detected AP event.