Multi-disease patient management
Systems and methods for monitoring patients with multiple chronic diseases are described. A system may include a health status monitor that receives diagnostic data including physiological signals sensed from a patient. The system may produce at least a first risk indication of the patient developing a first disease and a second risk indication of the patient developing a different second disease. The system may detect the first and second diseases from the physiological signals, and generate a composite health status indicator using the detections of the first and second diseases and the first and second risk indications. An alert of worsening health status may be generated if the composite detection score exceeds an alert threshold.
1. A medical-device system, comprising:
a risk stratification circuit configured to:
receive physiological information including respiration information and heart sound information sensed from a patient;
generate distinct first, second, and third signal metrics using the received physiological information, the first signal metric generated using the received respiration information, the second or the third signal metric generated using the received heart sound information;
calculate a primary pulmonary risk score using the first signal metric, and calculate a secondary pulmonary risk score using the second and the third signal metrics, the primary pulmonary risk score and the secondary pulmonary risk score each taking a numerical value; and
calculate a composite pulmonary risk score using the primary and the secondary pulmonary risk scores; and
a physiological event detector circuit configured to detect a cardiorespiratory event of the patient based at least in part on the calculated composite pulmonary risk score.
2. The medical-device system of claim 1 , wherein the physiological event detector circuit is configured to determine or adjust a detection threshold based at least in part on the calculated composite pulmonary risk score, and to automatically detect the cardiorespiratory event of the patient using the determined or adjusted detection threshold.
3. The medical-device system of claim 1 , wherein to automatically detect the cardiorespiratory event, the physiological event detector circuit is configured to:
calculate a cardiorespiratory event score using one or more physiological signals sensed from the patient;
determine or adjust an alert threshold based at least in part on the calculated composite pulmonary risk score; and
generate an alert of the cardiorespiratory event when the cardiorespiratory event score exceeds the alert threshold.
4. The medical-device system of claim 1 , wherein the cardiorespiratory event includes at least one of worsening heart failure (WHF), chronic obstructive pulmonary disease (COPD), asthma, or pulmonary edema.
5. The medical-device system of claim 1 , wherein the second or the third signal metric is selected from the group consisting of:
an intensity of a first (S1), a second (S2), or a third (S3) heart sound;
a timing of the S1, the S2, or the S3 heart sound;
a Q wave to S2 interval;
an S1 to S2 interval; or
a ratio of the S3 intensity to a reference heart sound intensity.
6. The medical-device system of claim 1 , wherein the risk stratification circuit is configured to calculate the secondary pulmonary risk score using measurements of the second signal metric sampled only at times when the third signal metric satisfies a specified condition.
7. The medical-device system of claim 6 , wherein the second signal metric include a respiratory rate and the third signal metric incudes a physical activity intensity or duration,
wherein the measurements of the second signal metric include respiratory rates measured during a time period when the physical activity intensity or duration exceeds a threshold.
8. The medical-device system of claim 1 , wherein the risk stratification circuit is configured to calculate the secondary pulmonary risk score using the second signal metric weighted by the third signal metric.
9. The medical-device system of claim 1 , wherein the risk stratification circuit is configured to calculate the composite pulmonary risk score using a linear or a nonlinear combination of the primary and secondary pulmonary risk scores.
10. The medical-device system of claim 1 , wherein the risk stratification circuit is configured to calculate the composite pulmonary risk score using a neural network taking the primary and the secondary pulmonary risk scores as input.
11. The medical-device system of claim 1 , comprising a therapy circuit configured to initiate or adjust a therapy to treat a cardiorespiratory disease in accordance with the calculated composite pulmonary risk score.
12. A method, comprising:
receiving physiological information including respiration information and heart sound information sensed from a patient;
generating, via a risk stratification circuit of a medical-device system, distinct first, second, and third signal metrics using the received physiological information, the first signal metric generated using the received respiration information, the second or the third signal metric generated using the received heart sound information;
calculating, via the risk stratification circuit, a primary pulmonary risk score using the first signal metric, and calculate a secondary pulmonary risk score using the second and the third signal metrics, the primary pulmonary risk score and the secondary pulmonary risk score each taking a numerical value;
calculating, via the risk stratification circuit, a composite pulmonary risk score using the primary and the secondary pulmonary risk scores; and
automatically detecting, via a physiological event detector circuit, a cardiorespiratory event of the patient based at least in part on the calculated composite pulmonary risk score.
13. The method of claim 12 , wherein the cardiorespiratory event includes at least one of worsening heart failure (WHF), chronic obstructive pulmonary disease (COPD), asthma, or pulmonary edema.
14. The method of claim 13 , wherein automatically detecting the cardiorespiratory even includes:
calculating a cardiorespiratory event score using one or more physiological signals sensed from the patient;
determining or adjusting an alert threshold based at least in part on the calculated composite pulmonary risk score; and
generating an alert of the cardiorespiratory event when the cardiorespiratory event score exceeds the alert threshold.
15. The method of claim 12 , wherein calculating the secondary pulmonary risk score includes using measurements of the second signal metric sampled only at times when the third signal metric satisfies a specified condition.
16. The method of claim 12 , wherein calculating the secondary pulmonary risk score includes using the second signal metric weighted by the third signal metric.
17. The method of claim 12 , wherein calculating the composite pulmonary risk score includes using a neural network taking the primary and the secondary pulmonary risk scores as input.
18. The method of claim 12 , further comprising initiating or adjusting a therapy to treat a cardiorespiratory disease in accordance with the calculated composite pulmonary risk score.
19. A medical-device system, comprising:
a risk stratification circuit configured to:
receive physiological information sensed from a patient;
generate distinct first, second, and third signal metrics using the received physiological information;
calculate a primary pulmonary risk score using measurements of the first signal metric, and calculate a secondary pulmonary risk score using measurements of the second signal metric sampled only at times when the third signal metric satisfies a specific condition, the primary pulmonary risk score and the secondary pulmonary risk score each taking a numerical value; and
calculate a composite pulmonary risk score using the primary and the secondary pulmonary risk scores; and
a physiological event detector circuit configured to detect a cardiorespiratory event of the patient based at least in part on the calculated composite pulmonary risk score.
20. The medical-device system of claim 19 , wherein the physiological event detector circuit is configured to determine or adjust a detection threshold based at least in part on the calculated composite pulmonary risk score, and to detect the cardiorespiratory event using the determined or adjusted detection threshold.