Method and device to monitor patients with kidney disease

Patent metadata

Field	Value
Publication number	US-9456755-B2
Application number	US-201213451461-A
Country	US
Kind code	B2
Filing date	Apr 19, 2012
Priority date	Apr 29, 2011
Publication date	Oct 4, 2016
Grant date	Oct 4, 2016

Abstract

A medical monitoring device for monitoring electrical signals from the body of a subject is described. The medical monitoring device monitors electrical signals originating from a cardiac cycle of the subject and associates each cardiac cycle with a time index. The medical monitoring device applies a forward computational procedure to generate a risk score indicative of hyperkalemia, hypokalemia or arrhythmia of the subject. The medical monitoring device can adjust the forward computational procedure based upon clinical data obtained from the subject.

First claim

We claim:

1. A medical monitor, comprising:
a medical device for determining body potassium status by monitoring electrical signals of the body of a subject;
a processor for applying a forward computational procedure to the electrical signals monitored from the body in communication with the medical device; and
a communication system indicating a condition of hyperkalemia, hypokalemia or arrhythmia of the subject based on at least one risk score;
wherein the medical device associates a cardiac cycle of the subject with a time index and calculates the at least one risk score, wherein the at least one risk score is associated with the time index;
wherein the at least one risk score is calculated by the forward computational procedure by the addition of a plurality of features converted to scalar feature scores on a common scale, wherein the addition of the feature scores can be weighted or non-weighted as provided in Equation 4:
Risk Score=
Σ k=1 n W k *P k   (Eq. 4)

wherein W k is a weighting factor, P k is a feature score, k is a feature number, and n is a number of features; and wherein the addition of the features scores is non-weighted when W k =1;
wherein the processor is configured to receive clinical information regarding the physiological state of the subject associated with the time index and makes an adjustment to the forward computational procedure based upon an error between the at least one risk score and the clinical information, and wherein the adjustment to the forward computational procedure based upon an error between the at least one risk score and the clinical information is done by the processor using a backward computational procedure, wherein the backward computational procedure adjusts exponential factors used to calculate the scalar feature score.

2. The medical monitor of claim 1 , wherein the medical device is implantable in the subject.

3. The medical monitor of claim 1 , wherein the medical device is an external device comprising a plurality of electrodes for placement on the skin of the subject.

4. The medical monitor of claim 1 , wherein the processor identifies a plurality of features of the cardiac cycle and compares the plurality of features to determinant values to calculate the at least one risk score using the forward computational procedure.

5. The medical monitor of claim 4 , wherein the plurality of features includes one or more selected from the group consisting of P-R interval, QRS width, Q-T interval, QT-dispersion, P-wave amplitude, P-wave peak, S-T segment depression, T-wave inversion, U-wave amplitude, T-wave peak amplitude, and heart rate variability.

6. The medical monitor of claim 4 , wherein a first risk score is calculated for a time index by applying a first forward computational procedure to one or more of the features of P-R interval, S-T segment depression, T-wave inversion and U-wave amplitude, wherein the processor increases a first alert counter by an incremental amount for each time index where the first risk score exceeds a predetermined risk score threshold and an alert is issued when the first alert counter exceeds a predetermined alert threshold.

7. The medical monitor of claim 6 , wherein the predetermined risk score threshold is determined based upon a baseline risk score value of the subject.

8. The medical monitor of claim 6 , wherein the first alert counter is increased for each consecutive time index where the first risk score exceeds the predetermined risk score threshold.

9. The medical monitor of claim 8 , wherein the predetermined risk score threshold is determined based upon a baseline risk score value of the subject.

10. The medical monitor of claim 6 , wherein the first alert counter is periodically reset if a sufficient number of time indices where the first risk score exceeds the predetermined risk score threshold is not observed over a time period.

11. The medical monitor of claim 10 , wherein the predetermined risk score threshold is determined based upon a baseline risk score value of the subject.

12. The medical monitor of claim 6 , wherein the first forward computational procedure determines a non-weighted or weighted sum of feature scores P1, P6, P7, P8 and P10 to calculate the first risk score and the feature scores are assigned a zero or non-zero value based on the following:
P1 based upon the feature P-R interval in time units,
P6 based upon the feature of depression of the S-T segment,
P7 based upon the feature of inversion of the T-wave,
P8 based upon the feature of U-wave amplitude in potential units, and
P10 is heart rate variation in time units.

13. The medical monitor of claim 4 , wherein at least one feature is monitored at a first time index and at a second time index defining a curve, wherein the processor increases an alert when the area under the curve exceeds a predetermined threshold.

14. The medical monitor of claim 4 , wherein the plurality of features includes one or more selected from the group consisting of QRS width, Q-T interval, P-wave amplitude, P-wave peak, T-wave amplitude and heart rate variation, and wherein a second risk score is calculated for a time index by applying a second forward computational procedure to the features of QRS width, Q-T interval, P-wave amplitude, P-wave peak, T-wave amplitude, and heart rate variation.

15. The medical monitor of claim 14 , wherein the second forward computational procedure determines a non-weighted or weighted sum of feature scores P2, P3, P4, P5, P9 and P10 and feature scores are assigned a zero or non-zero value based on the following:
P2 based upon the feature QRS width in time units,
P3 based upon the feature Q-T interval in time units,
P4 based upon the feature P-wave amplitude in potential units per time unit,
P5 based upon the feature P-wave peak in potential units,
P9 based upon the feature of T-wave amplitude in potential units and,
P10 is heart rate variation in time units.

16. The medical monitor of claim 4 , wherein a third risk score is calculated for a time index by applying a third forward computational procedure to one or more of the features of P-R interval, QRS width, Q-T interval, P-wave amplitude, P-wave peak, S-T segment, T-wave inversion, U-wave amplitude, T-wave peak amplitude, and heart rate variability.

17. The medical monitor of claim 16 , wherein the third forward computational procedure determines a non-weighted or weighted sum of feature scores P1 through P10 and feature scores are assigned a zero or non-zero value based on the following:
P1 based upon the feature P-R interval in time units,
P2 based upon the feature QRS width in time units,
P3 based upon the feature Q-T interval in time units,
P4 based upon the feature P-wave amplitude in potential units per time unit,
P5 based upon the feature P-wave peak in potential units,
P6 based upon the feature of depression of the S-T segment,
P7 based upon the feature of inversion of the T-wave,
P8 based upon the feature of U-wave amplitude in potential units,
P9 based upon the feature of T-wave amplitude in potential units, and
P10 is heart rate variation in time units.

18. The medical monitor of claim 17 , wherein the backward computational procedure adjusts one or more selected from the determinant values X C , weighting factors W k and an exponential factor k.

19. The medical monitor of claim 1 , wherein the feature value P k has a value of 0 or 1 or another integer value as determined by applying a discrete function to a corresponding feature of the cardia

Assignees

• Soykan Orhan
• Manda Venkatesh R
• Gerber Martin T
• Hobot Christopher M
• Medtronic Inc

Inventors

• Soykan Orhan
• Manda Venkatesh R
• Gerber Martin T
• Hobot Christopher M

Classifications

• A61B5/316

  Modalities, i.e. specific diagnostic methods · CPC title

• A61B5/349

  Detecting specific parameters of the electrocardiograph cycle · CPC title

• A61B5/318

  Heart-related electrical modalities, e.g. electrocardiography [ECG] · CPC title

• A61B5/0205 Primary

  Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition · CPC title

• A61M1/1601 Primary

  Control or regulation · CPC title