(19) United States
`(12) Patent Application Publication (10) Pub. No.: US 2009/0076343 A1
`(43) Pub. Date:
`Mar. 19, 2009
`James et al.
`
`US 20090076343A1
`
`(54) ENERGY MANAGEMENT FOR ADHERENT
`PATIENT MONITOR
`
`(75) Inventors:
`
`Kristofer J. James, Eagan, MN
`(US); Mark J. Bly, Falcon Heights,
`MN (US); Scott T. Mazar,
`Woodbury, MN (US); Jerry S.
`Wang, Blaine, MN (US)
`
`Correspondence Address:
`TOWNSEND AND TOWNSEND AND CREW,
`LLP
`TWO EMBARCADERO CENTER, EIGHTH
`FLOOR
`SAN FRANCISCO, CA 94111-3834 (US)
`
`(73) Assignee:
`(21) App1.No.:
`
`Corventis, Inc., San Jose, CA (US)
`
`12/209,274
`
`(22) Filed:
`
`Sep. 12, 2008
`
`Related U.S. Application Data
`
`(60)
`
`Provisional application No. 60/972,537, ?led on Sep.
`14, 2007, provisional application No. 60/972,336,
`?led on Sep. 14, 2007, provisional application No.
`
`60/972,340, ?led on Sep. 14, 2007, provisional appli
`cation No. 61/055,666, ?led on May 23, 2008, provi
`sional application No. 61/079,746, ?led on Jul. 10,
`2008.
`
`Publication Classi?cation
`
`(51) Int. Cl.
`A61B 5/02
`
`(2006.01)
`
`(52) U.S. Cl. ...................................................... .. 600/301
`
`(57)
`
`ABSTRACT
`
`A heart failure patient management system includes a detect
`ing system. The detecting system includes an adherent device
`con?gured to be coupled to a patient. The adherent device
`includes a plurality of sensors to monitor physiological
`parameters of the patient to determine heart failure status. At
`least one ID may be coupled to the adherent device that is
`addressable and unique to each adherent device. A Wireless
`communication device is coupled to the plurality of sensors
`and con?gured to transfer patient data directly or indirectly
`from the plurality of sensors to a remote monitoring system.
`The remote monitoring system is coupled to the Wireless
`communication device. An energy management device may
`be coupled to the plurality of sensors
`
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`FITBIT EXHIBIT 1004
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`Patent Application Publication
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`Mar. 19, 2009 Sheet 1 0f 8
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`US 2009/0076343 A1
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`Patent Application Publication
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`Mar. 19, 2009 Sheet 2 0f 8
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`Patent Application Publication
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`Mar. 19, 2009 Sheet 3 0f 8
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`Mar. 19, 2009 Sheet 4 0f 8
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`Patent Application Publication
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`Mar. 19, 2009 Sheet 6 0f 8
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`US 2009/0076343 A1
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`Patent Application Publication
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`Mar. 19, 2009 Sheet 8 0f 8
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`US 2009/0076343 A1
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`no
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`9 of 26
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`US 2009/0076343 A1
`
`Mar. 19, 2009
`
`ENERGY MANAGEMENT FOR ADHERENT
`PATIENT MONITOR
`
`CROSS-REFERENCES TO RELATED
`APPLICATIONS
`
`[0001] The present application claims the bene?t under 35
`USC 119(e) of US. Provisional Application Nos. 60/972,
`336, 60/972,537, 60/972,340 all ?led Sep. 14, 2007, 61/055,
`666 ?led May 23, 2008, and 61/079,746 ?led Jul. 10, 2008;
`the full disclosures of Which are incorporated herein by ref
`erence in their entirety.
`[0002] The subject matter of the present application is
`related to the following applications: Nos. 60/972,512;
`60/972,329; 60/972,354; 60/972,616; 60/972,363; 60/972,
`343; 60/972,581; 60/972,629; 60/972,316; 60/972,333;
`60/972,359; all ofWhich Were ?led on Sep. 14, 2007; 61/046,
`196 ?led Apr. 18, 2008; 61/047,875 ?led Apr. 25, 2008; and
`61/055,645, 61/055,656, 61/055,662 all ?led May 23, 2008.
`[0003] The following applications are being ?led concur
`rently With the present application, on Sep. 12, 2008: Attor
`ney Docket Nos. 026843-000110US entitled “Multi-Sensor
`Patient Monitor to Detect Impending Cardiac Decompensa
`tion Prediction”; 026843-000220US entitled “Adherent
`Device With Multiple Physiological Sensors”; 026843
`000410US entitled “Injectable Device for Physiological
`Monitoring”; 026843-000510US entitled “Delivery System
`for Injectable Physiological Monitoring System”; 026843
`000620US entitled “Adherent Device for Cardiac Rhythm
`Management”; 026843-000710US entitled “Adherent
`Device for Respiratory Monitoring”; 026843-000810US
`entitled “Adherent Athletic Monitor”; 026843-000910US
`entitled “Adherent Emergency Monitor”; 026843 -001320US
`entitled “Adherent Device With Physiological Sensors”;
`026843-001410US entitled “Medical Device Automatic
`Start-up upon Contact to Patient Tissue”; 026843-001900US
`entitled “System and Methods for Wireless Body Fluid Moni
`toring”; 026843-002010US entitled “Adherent Cardiac
`Monitor With Advanced Sensing Capabilities”; 026843
`002410US entitled “Adherent Device for Sleep Disordered
`Breathing”; 026843-002710US entitled “Dynamic Pairing of
`Patients to Data Collection GateWays”; 026843-003010US
`entitled “Adherent Multi-Sensor Device With Implantable
`Device Communications Capabilities”; 026843-003110US
`entitled “Data Collection in a Multi-Sensor Patient Monitor”;
`026843-003210US entitled “Adherent Multi-Sensor Device
`With Empathic Monitoring”; and 026843-003410US entitled
`“Tracking and Security for Adherent Patient Monitor.”
`
`BACKGROUND OF THE INVENTION
`
`[0004] 1. Field of the Invention
`[0005] This invention relates generally to systems and
`methods that use Wireless physiological monitoring, and
`more particularly to systems and methods for heart failure
`patient monitoring.
`[0006] Frequent monitoring of patients permits the
`patients’ physician to detect Worsening symptoms as they
`begin to occur, rather than Waiting until a critical condition
`has been reached. As such, home monitoring of patients With
`chronic conditions is becoming increasingly popular in the
`health care industry for the array of bene?ts it has the poten
`tial to provide. Potential bene?ts of home monitoring are
`numerous and include: better tracking and management of
`chronic disease conditions, earlier detection of changes in the
`
`patient condition, and reduction of overall health care
`expenses associated With long term disease management. The
`home monitoring of a number of diverse “chronic diseases” is
`of interest, Where such diseases include diabetes, dietary dis
`orders such as anorexia and obesity, anxiety, depression, epi
`lepsy, respiratory diseases, AIDS and other chronic viral con
`ditions, conditions associated With the long term use of
`immunosuppressants, e. g. in transplant patients, asthma,
`chronic hypertension, chronic use of anticoagulants, and the
`like.
`[0007] Of particular interest in the home monitoring sector
`of the health care industry is the remote monitoring of patients
`With heart failure (HF), also knoWn as congestive heart fail
`ure. HF is a syndrome in Which the heart is unable to e?i
`ciently pump blood to the vital organs. Most instances of HF
`occur because of a decreased myocardial capacity to contract
`(systolic dysfunction). HoWever, HF can also result When an
`increased pressure-stroke-volume load is imposed on the
`heart, such as When the heart is unable to expand suf?ciently
`during diastole to accommodate the ventricular volume, caus
`ing an increased pressure load (diasystolic dysfunction).
`[0008] In either case, HF is characterized by diminished
`cardiac output and/or damming back of blood in the venous
`system. In HF, there is a shift in the cardiac function curve and
`an increase in blood volume caused in part by ?uid retention
`by the kidneys. Indeed, many of the signi?cant morphologic
`changes encountered in HF are distant from the heart and are
`produced by the hypoxic and congestive effects of the failing
`circulation upon other organs and tissues. One of the major
`symptoms of HF is edema, Which has been de?ned as the
`excessive accumulation of interstitial ?uid, either localiZed or
`generaliZed.
`[0009] HF is the most common indication for hospitaliZa
`tion among adults over 65 years of age, and the rate of admis
`sion for this condition has increased progressively over the
`past tWo decades. It has been estimated that HF affects more
`than 3 million patients in the US. (I. B. O’Connell et al., J.
`Heart Lung Transpl. (1993) 13(4):S107-112).
`[0010] In the conventional management of HF patients,
`Where help is sought only in crisis, a cycle occurs Where
`patients fail to recogniZe early symptoms and do not seek
`timely help from their care-givers, leading to emergency
`department admissions (Miller, P. Z., 1995, “Home monitor
`ing for congestive heart failure patients,” Caring MagaZine,
`August 1995: 53-54). Recently, a prospective, randomiZed
`trial of 282 patients Was conducted to assess the effect of the
`intervention on the rate of admission, quality of life, and cost
`of medical care. In this study, a nurse-directed, multi disci
`plinary intervention (Which consisted of comprehensive edu
`cation of the patient and family, diet, social-service consulta
`tion and planning, revieW of medications, and intensive
`assessment of patient condition and folloW-up) resulted in
`feWer readmissions than the conventional treatment group
`and a concomitant overall decrease in the cost of care (M. W.
`Rich et al., NeW Engl. J. Med. (1995) 333:1190-95).
`[0011] Similarly, comprehensive discharge planning and a
`home folloW-up program Was shoWn to decrease the number
`of readmissions and total hospital charges in an elderly popu
`lation (M. Naylor et al., Amer. College Physicians (1994)
`120:999-1006). Therefore, home monitoring is of particular
`interest in the HF management segment of the health care
`industry.
`[0012] Another area in Which home-monitoring is of par
`ticular interest is in the remote monitoring of a patient param
`
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`
`eter that provides information on the titration of a drug, par
`ticularly With drugs that have a consequential effect following
`administration, such as insulin, anticoagulants, ACE inhibi
`tors, .beta.-blockers, diuretics, etc.
`[0013] Although a number of different home monitoring
`systems have been developed, there is continued interest in
`the development of neW monitoring systems. Of particular
`interest Would be the development of a system that provides
`for improved patient compliance, ease of use, etc. Of more
`particular interest Would be the development of such a system
`that is particularly suited for use in the remote monitoring of
`patients suffering from HP.
`[0014] There is a need for an improved home monitoring of
`patients With chronic conditions. There is a further need for an
`improved HF monitoring system.
`[0015] 2. Description of the Background Art
`[0016] The following US. Patents and Publications may
`describe relevant background art: US. Pat. Nos. 4,121,573;
`4,955,381; 4,981,139; 5,080,099; 5,353,793; 5,511,553;
`5,544,661; 5,558,638; 5,724,025; 5,772,586; 5,862,802;
`5,944,659; 6,047,203; 6,117,077; 6,129,744; 6,225,901;
`6,385,473; 6,416,471; 6,454,707; 6,527,711; 6,527,729;
`6,551,252; 6,595,927; 6,595,929; 6,605,038; 6,645,153;
`6,659,947; 6,821,249; 6,980,851; 6,988,989; 7,020,508;
`7,054,679; 7,130,396; 7,153,262; 2003/0092975; 2004/
`0225199; 2005/0113703; 2005/0131288; 2006/0010090;
`2006/0031102; 2006/0074462; 2006/0089679; 2006/
`0122474; 2006/0142820; 2006/0155183; 2006/0202816;
`2006/0224051; 2006/0235281; 2006/0264730; 2007/
`0015973; 2007/0021678; 2007/0038038; and 2007/0180047.
`
`BRIEF SUMMARY OF THE INVENTION
`
`[0017] Accordingly, an object of the present invention is
`toprovide an improved remote monitoring system of patients,
`for example patients With chronic conditions.
`[0018] Another object of the present invention is to provide
`an improved remote monitoring system for HF patients.
`[0019] A further object of the present invention is to pro
`vide a remote monitoring system for HF patients With at least
`one of an energy management device or at least one ID
`coupled to sensors to monitor a patient.
`[0020] A further object of the present invention is to pro
`vide a remote monitoring system for HF patients that uses
`outputs of a plurality of sensors have multiple features to
`enhance physiological sensing performance.
`[0021] Another object of the present invention is to provide
`a remote monitoring system for HF patients.
`[0022] Still a further object of the present invention is to
`provide a remote monitoring system for HF patients Where
`heart failure status is determined by a Weighted combination
`change in sensor outputs.
`[0023] Yet another object of the present invention is to
`provide a remote monitoring system for HF patients Where
`heart failure status is determined When a rate of change of at
`least tWo sensor outputs is an abrupt change in the sensor
`outputs as compared to a change in the sensor outputs over a
`longer period of time.
`[0024] A further object of the present invention is to pro
`vide a remote monitoring system for HF patients Where heart
`failure status is determined by a tiered combination of at least
`a ?rst and a second sensor output, With the ?rst sensor output
`indicating a problem that is then veri?ed by at least a second
`sensor output.
`
`[0025] Another object of the present invention is to provide
`a remote monitoring system for HF patients Where heart
`failure status is determined by a variance from a baseline
`value of sensor outputs.
`[0026] Yet another object of the present invention is to
`provide a remote monitoring system for HF patients Where
`baseline values are de?ned by a look up table.
`[0027] Still a further object of the present invention is to
`provide a remote monitoring system for HF patients Where
`heart failure status is determined When a ?rst sensor output is
`at a high value that is greater than a baseline value, and at least
`one of a second a third sensor outputs is at a high value also
`suf?ciently greater than a baseline value to indicate heart
`failure status.
`[0028] Another object of the present invention is to provide
`a remote monitoring system for HF patients Where heart
`failure status is determined by time Weighting the outputs of
`at least ?rst, second and third sensors, and the time Weighting
`indicates a recent event that is indicative of the heart failure
`status.
`[0029] These and other objects of the present invention can
`be achieved in many embodiments comprising a patient
`monitoring system that includes a detecting system. The
`detecting system has, (i) an adherent device con?gured to be
`coupled to a patient, the adherent device including a plurality
`of sensors that monitors physiological parameters of the
`patient, for example physiological parameters to determine
`heart failure status, (ii) at least one ID coupled to the adherent
`device that is addressable and unique to each adherent device,
`and (iii) a Wireless communication device coupled to the
`plurality of sensors and con?gured to transfer patient data
`from the plurality of sensors to a remote monitoring system.
`The remote monitoring system is coupled to the Wireless
`communication device. An energy management device may
`be coupled to the plurality of sensors so as to minimiZe poWer
`consumption When the patch is Worn by the patient.
`[0030] In a ?rst aspect, embodiments of the present inven
`tion provide a system for monitoring a patient. The system
`comprises a patient detecting system and a remote monitoring
`system. The patient detecting system can measure the patient
`and includes an adherent device con?gured to be coupled to a
`patient. The adherent device comprises a plurality of sensors
`to measure physiological parameters of the patient to deter
`mine physiologic status of the patient. The patient detecting
`system also includes an energy management device coupled
`to the plurality of sensors and a Wireless communication
`device coupled to the plurality of sensors. The remote moni
`toring system is coupled to the Wireless communication
`device and is con?gured to transfer patient data from the
`plurality of sensors to the remote monitoring system.
`[0031] In many embodiments, an energy generation device
`is coupled to the energy management device.
`[0032] In many embodiments, the energy management
`device is part of the patient detecting system. The adherent
`device may be con?gured to sample intermittently. For
`example, the plurality of sensors may be con?gured to sample
`no more than 30 seconds for every minute for ECG, no more
`than once per second for an accelerometer sensor and no more
`than 60 seconds for every 15 minutes for impedance.
`[0033] The plurality of sensors may be con?gured to mea
`sure at least one of bioimpedance, heart rate, heart rhythm,
`HRV, HRT, heart sounds, respiratory sounds, blood pressure,
`activity, posture, Wake/ sleep, orthopnea, temperature, heat
`?ux or patient activity. The plurality of sensor may be con
`
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`?gured to measure the patient activity With at least one of a
`ball switch, an accelerometer, minute ventilation, heart rate,
`bioimpedance, noise, skin temperature, heat ?ux, blood pres
`sure, muscle noise or patient posture.
`[0034] In many embodiments, the plurality of sensors is
`con?gured to sWitch betWeen different modes. The different
`modes comprise a ?rst mode and a second mode, the ?rst
`mode different from the second mode.
`[0035] The energy management device may be con?gured
`to deactivate selected sensors to reduce redundancy and
`reduce poWer consumption. The energy management device
`may be con?gured to use sensor cycling for energy manage
`ment. The plurality of sensors may comprise a ?rst portion of
`sensors and a second portion of sensors. The ?rst portion can
`be con?gured to sample at ?rst times and the second portion
`can be con?gured to sample at second times. The ?rst times
`may be different from the second times, and the energy man
`agement device may be con?gured to cycle sampling betWeen
`the ?rst sensors and the second sensors.
`[0036] The plurality of sensors may comprise a ?rst core
`sensor and a second sensor. The ?rst core sensor is con?gured
`to continuously monitor and detect While the second sensor is
`con?gured to verify a physiological status in response to the
`core sensor raising a ?ag. The plurality of sensors may com
`prise a ?rst portion and a second portion. The ?rst portion is
`different from the second portion. The ?rst portion is con?g
`ured for short term tracking and the second portion of the
`sensors is con?gured for long term tracking.
`[0037] The adherent device may be con?gured to be acti
`vated. The adherent device may be activated by at least one of
`a physiological trigger, automatic impedance, a tab pull, bat
`tery insertion, a hall or reed sWitch, a breakable glass capsule,
`a dome sWitch, by light activation, pressure activation, body
`temperature activation, a connection betWeen electronics
`associated With the sensors and the adherent device, exposure
`to air and by a capacitive skin sensor.
`[0038] The energy management device may be con?gured
`to perform at least one of modulate a clock speed to optimiZe
`energy, monitor cell voltage dropiunload cell, monitor cou
`lomb-meter or other battery monitor, battery end of life
`dropoff to transfer data, elective replacement indicator, call
`center noti?cation, sensing WindoWs by the sensors based on
`a monitored physiological parameter or sensing rate control.
`The energy generation device may be con?gured to generate
`energy by at least one of a thermo-electric unit, kinetics, fuel
`cell, through solar poWer, a Zinc air interface, Faraday gen
`erator, internal combustion, a micro-battery and With a
`rechargeable device.
`[0039] In many embodiments, the system further com
`prises a processor. The processor comprises a tangible
`medium coupled to the plurality of sensors and to the Wireless
`communication device. The processor is con?gured to
`receive patient data from the plurality of sensors and process
`the patient data. The processor may be located at the remote
`monitoring system. The processor may be included in a moni
`toring unit, Which comprises part of the patient detecting
`system. Logic resources may be located at the monitoring
`unit. These logic resources determine a physiological event of
`a patient.
`[0040] In many embodiments, the system further com
`prises logic resources located at the remote monitoring sys
`tem. These logic resources may determine a physiological
`status of the patient and detect a physiological event of a
`patient.
`
`[0041] In many embodiments, the system further com
`prises a processor system. The processor system comprises a
`tangible medium and has program instructions for evaluating
`values received from the plurality of sensors With respect to
`acceptable physiological ranges for each value received by
`the processor.
`[0042] The Wireless communication device may be con?g
`ured to receive instructional data from the remote monitoring
`system. The Wireless communication device may comprise at
`least one of a modem, a serial interface, a LAN connection
`and a Wireless transmitter. The Wireless communication
`device may include a receiver and a transmitter for receiving
`data indicating the values of the physiological event detected
`by the plurality of sensors, and for communicating the data to
`the remote monitoring system. The Wireless communication
`device may comprise a Wireless local area netWork for receiv
`ing data from the plurality of sensors. The Wireless commu
`nication device may include a data storage for recording the
`data received from the plurality of sensors. The Wireless
`communication device may include an access device for
`enabling access to information recorded in the data storage
`from the remote monitoring system. The Wireless communi
`cation device may include a controller con?gured to control
`sending of the data supplied by the plurality of sensors.
`[0043] In many embodiments, the system further com
`prises an external device coupled to the adherent device com
`prising the plurality of sensors. The external device may
`comprise at least one of a Weight scale, a blood pressure cuff,
`a medical treatment device or a medicament dispenser.
`[0044] In many embodiments, the system further com
`prises a noti?cation device coupled to the patient detecting
`system and the remote monitoring system. The noti?cation
`device is con?gured to provide a noti?cation When values
`received from the plurality of sensors are outside acceptable
`physiological ranges. The patient measurement system may
`be con?gured to measure physiological parameters at a high
`rate of sampling in response to a trigger from at least one of a
`medical provider, the remote monitoring system or a medical
`treatment device. The at least one of the medical provider, the
`remote monitoring system or the medical treatment device are
`con?gured to trigger the high-rate of sampling of the physi
`ological parameters for alert veri?cation. The noti?cation
`device may be con?gured to communicate With the at least
`one of the patient, a clinician, a spouse, a family member, a
`caregiver or a medical provider When the values received
`from the plurality of sensors are not Within acceptable physi
`ological ranges. The noti?cation device may further be con
`?gured to communicate from one device to another device,
`thereby alloWing for therapeutic intervention to prevent dec
`ompensation When the values received from the plurality of
`sensors are not Within acceptable physiological ranges.
`[0045] In many embodiments, the system further com
`prises a memory management device. The memory manage
`ment device is con?gured to perform at least one of data
`compression, prioritizing of sensing by a sensor, monitoring
`at least some from at least some of the sensors, sensing by the
`sensors in real time, noise blanking such that sensor data is
`not stored When noise above a selected level is determined,
`loW-poWer of battery caching or decimation of old sensor
`data.
`[0046] The adherent device may comprise a Wearable patch
`that includes a battery.
`[0047] The physiological status of the patient may com
`prise a heart failure status. At least one of the patient detecting
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`system or the remote monitoring system may comprise a
`processor system con?gured to determine the heart failure
`status of the patient in response to the physiological param
`eters.
`[0048] The plurality of sensors may comprise a combina
`tion of at least tWo sensors con?gured to detect or predict
`decompensation. The combination may be con?gured to
`measure at least tWo of an electrocardiogram signal, a hydra
`tion signal, an accelerometer signal or a respiration signal of
`the patient.
`[0049] The remote monitoring system may include a
`receiver, a transmitter and a display for displaying data rep
`resentative of values of at least one physiological event
`detected by the plurality of sensors.
`[0050] The remote monitoring system may include a data
`storage mechanism and a comparator. The data storage
`mechanism has a plurality of acceptable ranges for physi
`ological values stored therein. The comparator compares the
`data received from the monitoring system With the acceptable
`ranges stored in the data storage device.
`[0051] The remote monitoring system may include a por
`table computer. The remote monitoring system may comprise
`a portable unit having a display screen and a data entry device
`for communicating With the Wireless communication device.
`[0052] In another aspect, embodiments of the invention
`provide a device for monitoring a patient. The device com
`prises an adherent device comprising a plurality of sensors,
`sensor circuitry coupled to the plurality of sensors, Wireless
`circuitry and energy management circuitry. The adherent
`device is con?gured to couple to a skin of the patient. The
`sensor circuitry comprises electrocardiogram circuitry, bio
`impedance circuitry, accelerometer circuitry, and tempera
`ture sensor circuitry. The poWer management device is
`coupled to the Wireless circuitry and con?gured to transmit
`data from the sensor circuitry With a Wireless circuitry duty
`cycle of no more than about 5%.
`[0053] In many embodiments, the device is con?gured to
`monitor continuously a patient health status in response to the
`plurality of sensors.
`[0054] In many embodiments, the patient may comprise a
`heart failure patient and the adherent device is con?gured to
`continuously monitor the heart failure status With the Wireless
`circuitry duty cycle of no more than about 5%.
`[0055] In many embodiments, a majority of the sensor cir
`cuitry comprises a duty cycle of no more than about 5%. For
`example, the electrocardiogram circuitry may comprise a
`duty cycle of no more than about 40%; the bioimpedance
`circuitry may comprise a duty cycle of no more than about
`10%; the accelerometer circuitry may comprise a duty cycle
`of no more than about 1%; and the temperature sensor cir
`cuitry may comprise a duty cycle of no more than about 1%.
`[0056] The poWer management device may comprise a
`timer coupled to the sensor circuitry to determine the duty
`cycle of each sensor.
`[0057] In many embodiments, the device further comprises
`a processor. The processor comprises a tangible medium
`coupled to the sensor circuitry and is con?gured With the
`timer to sample data from the sensor circuitry. The adherent
`device is con?gured to support the processor, the plurality of
`sensors, the sensor circuitry, the Wireless circuitry and the
`energy management circuitry With the skin of the patient.
`[0058] In many embodiments, the processor is con?gured
`to determine a heart rate of the patient in response to the
`
`electrocardiogram circuitry. The processor may also be con
`?gured to determine a respiration of the patient in response to
`the bioimpedance circuitry.
`[0059] In many embodiments, the device further comprises
`a processor system. The processor system comprises the pro
`cessor and a second processor at a remote location. The sec
`ond processor is Wirelessly coupled to the processor sup
`ported With adherent device. The processor system is
`con?gured to detect decompensation of a heart failure patient
`in response to output from the plurality of sensors. The second
`processor at the remote location may be con?gured to com
`bine the output from the plurality of sensors detect the dec
`ompensation of the heart failure patient. The second proces
`sor at the remote location can be con?gured to determine a
`respiration rate of the patient at the remote location in
`response to the bioimpedance circuitry.
`[0060] In many embodiments, the device comprises at least
`one battery con?gured to poWer the electrocardiogram cir
`cuitry, the bioimpedance circuitry and the accelerometer cir
`cuitry and the temperature sensor circuitry for at least about
`one Week When the adherent device is adhered to the skin of
`the patient. The adherent device may be con?gured to con
`sume no more than about 1500 mA Hours per day When the
`adherent device is adhered to the patient for an extended
`period of at least about one Week.
`[0061] In another aspect, embodiments of the present
`invention provide a method for monitoring a patient. The
`method comprises adhering an adherent device to a skin of the
`patient. The adherent device comprises a plurality of sensors.
`Patient data are measured With sensor circuitry coupled to the
`plurality of sensors. The sensor circuitry comprises at least
`one of electrocardiogram circuitry, bioimpedance circuitry,
`accelerometer circuitry, or temperature sensor circuitry. The
`patient data is transmitted With Wireless transmission cir
`cuitry supported the skin of the patient to a remote monitoring
`system. The Wireless transmission circuitry transmits the
`patient data intermittently With a duty cycle of no more than
`about 5%.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`[0062] FIG. 1 is a block diagram illustrating one embodi
`ment of a patient monitoring system of the present invention;
`[0063] FIGS. 2A and 2B illustrate exploded vieW and side
`vieWs of embodiments of an adherent device With sensors
`con?gured to be coupled to the skin of a patient for monitor
`ing purposes;
`[0064] FIG. 3 illustrates one embodiment of an energy
`management device that is coupled to the plurality of sensors
`of FIG. 1;
`[0065] FIG. 4 illustrates one embodiment of present inven
`tion illustrating logic resources con?gured to receive data
`from the sensors and/ or the processed patient for monitoring
`purposes, analysis and/or prediction purposes;
`[0066] FIG. 5 illustrates an embodiment of the patient
`monitoring system of the present invention With a memory
`management device;
`[0067] FIG. 6 illustrates an embodiment of the patient
`monitoring system of the present invention With an external
`device coupled to the sensors;
`[0068] FIG. 7 illustrates an embodiment of the patient
`monitoring system of the present invention With a noti?cation
`device;
`[0069] FIG. 8 is a block diagram illustrating an embodi
`ment of the present invention With sensor leads that convey
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`signals from the sensors to a monitoring unit at the detecting
`system, or through a Wireless communication device to a
`remote monitoring system;
`[0070] FIG. 9 is a block diagram illustrating an embodi
`ment of the present invention With a control unit at the detect
`ing system and/or the remote monitoring system;
`[0071] FIG. 10 is a block diagram illustrating an embodi
`ment of the present invention Where a control unit enco