Techniques for obtaining impedance data to provide an early warning for heart failure decompensation are described. An example device may be configured to measure subcutaneous impedance values, and increment an impedance score. In some examples, the device may use an adaptive threshold and fluid index in incrementing the impedance score. In some examples, the impedance score is compared to a threshold to determine a heart failure status of a patient.

In one embodiment, a method for operating a system for management of implantable medical devices (IMDs), comprises: conducting communications sessions with a plurality of clinician programmer devices, wherein some of the communication sessions occur while the plurality of clinician programmer devices are engaged in respective programming sessions with IMDs; conducting communications sessions with a plurality of patient controller devices, wherein the communication sessions with the patient controller devices include communication of data pertaining to offline programming of IMDs; reconciling programming session data received from the plurality of clinician programmer devices with programming session data received from patient controller devices to identify instances of unauthorized IMD programming; and distributing revocation data to patient controller devices to be downloaded to corresponding IMDs, wherein the revocation data identifies cryptographic keys that are no longer trusted.

A system may include a first device and a second device. The first device may be configured to send advertising packets with a request to communicate with the second device, and the second device may be configured to discover the first device and initiate a wireless communication session with the first device using the advertising packets. The first device may be configured to send advertising packets and send a request to communicate with the second device, and the second device may be configured to discover the first device and initiate a wireless communication session with the first device using the advertising packets.

A method for determining and responding in real-time to an increased risk of death relating to a patient with epilepsy is provided. The method includes receiving cardiac data and determining a cardiac index based upon the cardiac data. The method includes determining an increased risk of death associated with epilepsy if the indices are extreme, issuing a warning of the increased risk of death and logging information related to the increased risk of death. Also presented is a second method for determining and responding in real-time to an increased risk of death relating to a patient with epilepsy comprising receiving at least one of arousal data, responsiveness data or awareness data and determining an arousal index, a responsiveness index or an awareness index, where the indices are based on arousal data, responsiveness data or awareness data respectively. The second method includes determining an increased risk of death related to epilepsy if indices are extreme values, issuing a warning of the increased risk of death and logging information related to the increased risk of death. A computer readable program storage device is also provided. Also provided is a method for receiving body data, determining a cardiac, an arousal, a responsiveness, or a kinetic index, determining an increased or increasing risk of death over a first time window relating to a patient with epilepsy and issuing a warning and logging relevant information.

Described here is a deep brain stimulation (DBS) approach that targets several relevant nodes within brain circuitry, while monitoring multiple symptoms for efficacy. This approach to multi-symptom monitoring and stimulation therapy may be used as an extra stimulation setting in extant DBS devices, particularly those equipped for both stimulation and sensing. The therapeutic efficacy of DBS devices is extended by optimizing them for multiple symptoms (such as sleep disturbance in addition to movement disorders), thus increasing quality of life for patients.

An implantable cardioverter defibrillator (ICD) receives a cardiac electrical signal by a sensing circuit while operating in a sensing without pacing mode and detects asystole based on the cardiac electrical signal. The ICD determines, in response to detecting the asystole, if asystole backup pacing is enabled, and automatically switches to a temporary pacing mode in response to the asystole backup pacing being enabled. Other examples of detecting asystole and providing a response to detecting asystole by the ICD are described herein.

In one embodiment, a WCD is described. The WCD includes a support structure configured to be worn by a patient and a processor coupled to the support structure. The WCD also includes an energy storage module configured to store an electrical charge and in communication with the processor. The WCD also includes a discharge circuit coupled to the energy storage module, the discharge circuit in communication with the processor and configured to discharge the stored electrical charge through a body of the patient. The processor is configured to detect an event at the WCD, classify the detected event, and determine an alarm onset time of the detected event based at least in part on the event classification. The processor is further configured to issue the alarm after the alarm onset time.

In one embodiment, a WCD is described. The WCD includes a support structure configured to be worn by a patient and a processor coupled to the support structure. The WCD also includes an energy storage module configured to store an electrical charge and in communication with the processor. The WCD also includes a discharge circuit coupled to the energy storage module, the discharge circuit in communication with the processor and configured to discharge the stored electrical charge through a body of the patient. The processor is configured to detect an event at the WCD, classify the detected event, and determine an alarm onset time of the detected event based at least in part on the event classification. The processor is further configured to issue the alarm after the alarm onset time.

Embodiments described herein generally relate to methods and systems for monitoring and responding to changes in a patient's physiologic status. A method includes sensing pulmonary arterial pressure (PAP) and thoracic impedance of a patient at rest. The method also includes detecting, based on the sensed PAP, whenever the patient's PAP at rest is outside an acceptable range of PAP measures for the patient at rest, and detecting, based on the sensed thoracic impedance, whenever the patient's respiration at rest is outside an acceptable range of respiration measures for the patient at rest. Various different actions are triggered depending upon whether the patient's PAP at rest is outside the acceptable range of PAP measures for the patient at rest, and whether the patient's respiration at rest is within the acceptable range of respiration measures for the patient at rest. Other embodiments relate to similar methods performed at other levels of exertion.

A method of monitoring depth of muscle relaxation of a patient includes applying a series of stimulations to a nerve of a patient and measuring muscle responses thereto. A maximal stimulus current, a supramaximal stimulus current, and/or a submaximal stimulus current are determined based on the muscle responses, wherein the maximal stimulus current is a current at which a maximal muscle response is produced from stimulating the nerve, the supramaximal stimulus current is greater than or equal to the maximal stimulus current, and the submaximal stimulus current is less than the maximal stimulus current. A first set of stimulations are applied to the nerve of the patient. Either the supramaximal stimulus current or the submaximal stimulus current are then selected for a subsequent series of stimulations based on the measured muscle responses to the first series of stimulations, and the subsequent series of stimulations are performed accordingly to monitor the patient's depth of muscle relation.