Abstract:
Systems, apparatuses, and methods are disclosed for optimizing management of one or more implanted artificial heart pumps. An example method includes wirelessly retrieving, via one or more portable diagnostic devices, data regarding the one or more implanted artificial heart pumps. The example method further includes analyzing, by a server device, performance characteristics of the one or more implanted artificial heart pumps based on the retrieved data. The example method further includes causing rendering of the performance characteristics. Corresponding apparatuses and computer program products are contemplated.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of U.S. Provisional Patent Application No. 62/256,659, filed Nov. 17, 2015, the entire disclosure of which is incorporated herein by reference. 
     
    
     TECHNOLOGICAL FIELD 
       [0002]    Example embodiments of the present invention relate generally to implanted artificial heart pumps that indirectly measure flow and, more particularly, to methods and apparatuses for acquiring and analyzing data from implanted artificial heart pumps. 
       BACKGROUND 
       [0003]    In the field of artificial heart-assist technology, advances in the mechanical design of implantable circulatory pumps have been complemented by similar improvements in their external control units. These units have been designed to be increasingly sensitive to the dynamic interaction between the blood pump and the patient&#39;s heart to better provide end-users with real-time information that can be used to measure the machine&#39;s performance under particular operating parameters. 
         [0004]    While blood flow measurement through the artificial heart pump is most accurate when received directly from an actual probe inserted into the outflow track of the pump conduit, implanted sensors that maintain direct contact with blood can perturb its flow and activate factors within the blood that increase the risk of blood clot formation. These clots can disturb motor blade performance and cause complete machine malfunction. When this occurs, total pump replacement may be required, mandating a high-risk open chest surgery. In the United States, direct flow heart pumps are limited, by regulation, to investigational use only. Only indirect flow measurement technology is approved by the Food and Drug Administration (FDA) for widespread therapeutic use in the United States, and heart pump engineering trends are producing new indirect-flow prototypes that are more reliable and durable than previous iterations because they continue to reduce the number of high resistance areas in the interface between the pump&#39;s surface and the patient&#39;s blood. Currently, the newest “3 rd  generation” heart pump models all estimate flow indirectly without the use of direct sensor components. 
         [0005]    As an alternative to the placement of direct measurement sensors in the body, heart pump performance can be indirectly estimated using engineering formulas that relate motor torque, fluid flow rate, and the pressure of fluid moved by the motor at a particular speed. For most heart pumps, the speed of the moving motor blades that propel blood forward through the heart is the one fixed variable that can be adjusted by the end-user. Because the motors are based on brushless, direct-current design, the torque they generate is directly proportional to the power they consume in electrical current. By measuring the real-time power demands of a pump, the torque variable can be estimated. Once both torque and speed variables are known, flow and pump head pressure (the difference in pressure between the inflow and outflow portions of the pump) can be estimated. Heart pumps differ from each other in certain design characteristics that cause them to react idiosyncratically when they consume power to propel blood through the circulation. As a result, each pump utilizes its own proprietary program to convert current usage to torque and to calculate the effects of blood viscosity on the motor. 
         [0006]    In its current design configuration, to obtain real-time flow measurements for heart pump technology based on indirect flow estimations, a portable controller must be attached to a larger monitor. Depending on the manufacturer, the monitor contains the software to display continuous flow data, either numerically alone or both numerically and in a waveform format. These monitors are cost prohibitive for individual patient use, and only intended for diagnosing and managing heart pump-related issues in hospital or clinic facilities where expert personnel are available to titrate the motor speed to optimal flow dynamics. After hospital discharge, and between outpatient clinic visits every several months, the heart pump device functions according to the most recent settings and cannot respond dynamically to any change in the patient&#39;s physiology. 
         [0007]    The inability to remotely discern heart pump operating variables, characterize their trends over time, and assess their interactions with the native heart represents a missed opportunity to better utilize this transformative technology. The infrequent contact between expert and patient due to logistical constraints results in a necessarily passive heart pump utilization strategy that precludes maximal titration of the heart pump to respond to the patient&#39;s changing circulatory status. High motor rotating speeds can cause greater emptying of the left heart than physiologically appropriate and precipitate suction problems between the inlet port and the heart wall, especially in low volume situations. Because patients receive limited supervision as outpatients, clinicians and engineers may enter long-term speed settings that are lower than optimal to provide a safety margin against heart pump suction complications. However, this added safety is gained at the cost of the pump&#39;s full potential to support the heart, which could be achieved with higher operating speeds. This is undesirable because heart failure is a dynamic process: either the patient&#39;s native circulatory function is improving with the support of the pump and gradually recovering lost function or it is further deteriorating as a result of intrinsic, irreversible disease—opposite trends that require divergent heart pump management strategies. Level of patient daily activity and hydration status are other variable factors that can influence the optimal operating target speed of a particular heart pump. 
         [0008]    A device with the capability to remotely monitor disease progression in patients with implanted artificial heart pumps, including those using the indirect-flow measurement algorithms on which the great majority of heart pumps operate, could form the cornerstone of a more nuanced heart pump management strategy by facilitating expert oversight of the patient and the implanted artificial heart pump in a non-clinical setting. A system employing such a device could utilize software packages to create dynamic models of the heart pump flow patterns and the patient&#39;s cardiac performance to guide fine-tuning of speed adjustments. Such an innovation would be useful for ensuring the most satisfactory pump performance and identifying problem trends requiring early intervention to prevent severe complications, including hospitalization or death. 
       BRIEF SUMMARY 
       [0009]    Accordingly, example embodiments described herein demonstrate methods and apparatuses for the remote monitoring and assessment of implantable artificial heart pumps, including those that indirectly measure flow. Some example embodiments rely on indirect measurement of blood flow and blood pressure characteristics to guide decision-making regarding the optimum operating parameters of the machine. Because many implantable artificial heart pumps are designed for long-term use in the outpatient setting, example embodiments described herein greatly expand the oversight capability and permit more data-driven optimization of indirect flow measurement blood pumps without added interference with recipients&#39; quality of life and independence. 
         [0010]    In a first aspect of the invention, a diagnostic device is contemplated that will attach to the site on the heart pump controller at the connector location designed by the manufacturer to interface directly with a supplemental monitor used in clinical settings. In normal outpatient operations, this port is either not utilized or supports a redundant connection to the external battery pack. However, as described below, this port may be used in some example embodiments to continuously query the internal heart pump&#39;s external portable controller to gather data on power consumption and other operating variables estimated by the controller using manufacturer-specific algorithms. In some embodiments, the transfer of data from the heart pump to the diagnostic device may be restricted to a single direction to protect the integrity of the system by ensuring that changes to the operating speed can only occur with manual adjustment. As described below, the diagnostic device may also be designed to record problem-event alarms that are activated by the pump controller when the estimated flow either exceeds or falls below manufacturer-specified parameters. Currently, this real-time data is inaccessible to expert decision makers during the interval period that a patient is outside of a formal medical environment. 
         [0011]    In another aspect of the invention, the diagnostic device may contain a wireless transmitter to send heart pump performance data to remote monitoring servers for processing and analysis. The transmission technology may, in some embodiments, have the capability to communicate across multiple wireless bandwidths, including low-power radio frequencies and those allocated by the Federal Communications Commission (FCC) for exclusive medical usage. This aspect of the invention, for the first time, allows indirect flow measurements and other pump performance characteristics to be remotely retrieved. It should be understood that in some embodiments, the heart pump controller may be itself be designed to carry out wireless transmissions, and in such embodiments, the heart pump controller can transfer the heart pump performance data to the remote monitoring servers without the need to utilize a separate diagnostic device as an intermediary. 
         [0012]    In another aspect of the invention, a receiving computer server at a remote site location may receive the transmitted signals from the device and use a software application to process the heart pump performance and estimate additional physiological variables using mathematical algorithms. The receiving computer may, in this regard, also arrange the data in an integrated visual platform that provides more clinical information than the raw engineering numbers heretofore generated by manufacturers&#39; software and may present that information in a more intuitive fashion for expert end-users. As a result, this aspect of the invention may better promote best-practice clinical decisions regarding heart pump use than currently exist for indirect flow measurement machines. 
         [0013]    The above summary is provided merely for purposes of summarizing some example embodiments to provide a basic understanding of some aspects of the invention contemplated herein. Accordingly, it will be appreciated that the above-described embodiments are merely examples and should not be construed to narrow the scope or spirit of the invention in any way. It will be appreciated that the scope of the invention encompasses many potential embodiments in addition to those here summarized, some of which will be further described below. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]    Having thus described some example embodiments in general terms, reference will now be made to the accompanying drawings, which are not necessarily drawn to scale. 
           [0015]      FIG. 1  provides a schematic block diagram of an example system comprising diagnostic device in contact with a ventricular assist device and a remote server, in accordance with example embodiments described herein. 
           [0016]      FIGS. 2A, 2B, 2C, and 2D  illustrate a series of perspective views of an example wireless diagnostic device having a hub connector designed to interface with a certain proprietary heart pump controller, in accordance with example embodiments described herein. 
           [0017]      FIGS. 3A, 3B, 3C, and 3D  provides a multi-dimensional view of another example wireless diagnostic device with a hub connector designed to interface with an alternate proprietary heart pump controller, in accordance with example embodiments described herein. 
           [0018]      FIG. 4  illustrates a flowchart describing example operations for analyzing data retrieved from an implanted artificial heart pump that indirectly measures flow by a diagnostic device, in accordance with example embodiments described herein. 
           [0019]      FIG. 5  provides an illustration of a user interface provided by an example remote heart pump monitoring application that provides a visual dashboard for assessing data acquired from the heart pump and patient-related physiological estimates, in accordance with example embodiments described herein. 
           [0020]      FIG. 6  provides an illustration of a high-level system diagram in accordance with example embodiments described herein. 
       
    
    
     DETAILED DESCRIPTION 
       [0021]    Some example embodiments will now be described more fully with reference to the accompanying drawings, in which some, but not all, contemplated embodiments are shown. Indeed, the contemplated inventions may be embodied in many different forms and should not be construed as limited to the example embodiments set forth herein; rather, these example embodiments are provided so that this disclosure will satisfy applicable legal requirements. Like numbers refer to like elements throughout. As used herein, “data,” “content,” “information,” and similar terms may be used interchangeably to refer to data capable of being transmitted, received, and/or stored in accordance with embodiments of the present invention. Thus, use of any such terms should not be taken to limit the spirit or scope of the present invention. 
         [0022]    As used herein, a “computer-readable storage medium,” which refers to a non-transitory physical storage medium (e.g., a volatile or non-volatile memory device), can be differentiated from a “computer-readable transmission medium,” which refers to an electromagnetic signal. 
         [0023]    As used herein, a “processor,” which may comprise, for example, microprocessor  24 , processor  74 , or the like, may be embodied in a number of different ways. For example, the processor may be embodied as one or more of various hardware processing means such as a co-processor, a microprocessor, a controller, a digital signal processor (DSP), a processing element with or without an accompanying DSP, or various other processing circuitry including integrated circuits such as, for example, an ASIC (application specific integrated circuit), an FPGA (field programmable gate array), a microcontroller unit (MCU), a hardware accelerator, a special-purpose computer chip, or the like. As such, in some embodiments, the processor may include one or more processing cores configured to perform independently. A multi-core processor may enable multiprocessing within a single physical package. Additionally or alternatively, the processor may include one or more processors configured in tandem via the bus to enable independent execution of instructions, pipelining, and/or multithreading. 
         [0024]    In example embodiments, the processor may be configured to execute instructions stored in a memory (e.g., memory devices  25  or  77 ) or otherwise accessible to the processor. Alternatively or additionally, the processor may be configured to execute hard-coded functionality. Thus, for example, when the processor is embodied as an ASIC, FPGA, or the like, the processor may comprise specifically configured hardware for conducting operations described herein. Alternatively, as another example, when the processor is embodied as an executor of software instructions, the instructions may specifically configure the processor to perform the algorithms and/or operations described herein when the instructions are executed. The processor may include, among other things, a clock, an arithmetic logic unit (ALU), and logic gates configured to support operation of the processor. 
         [0025]    In turn, as used herein a “memory,” such as memory devices  25  and  77  may be non-transitory and may include, for example, one or more volatile and/or non-volatile memories. In other words, for example, the memory may be an electronic storage device (e.g., a computer readable storage medium) comprising gates configured to store data (e.g., bits) that may be retrievable by a machine (e.g., a computing device like the processor). The memory may be configured to store information, data, content, applications, instructions, or the like, for enabling an apparatus to carry out various functions in accordance with an example embodiments described herein. For example, the memory could be configured to buffer input data for processing by the processor. Additionally or alternatively, the memory could be configured to store instructions for execution by the processor. 
         [0026]    Having discussed some example terminology used herein, some example embodiments of the present invention will now be described in greater detail. The following example embodiments describe methods and apparatuses for the remote monitoring and assessment of implantable artificial heart pumps without internal flow sensors. These example embodiments rely on indirect measurement of blood flow and blood pressure characteristics to guide decision-making regarding the optimum operating parameters of the machine. 
         [0027]      FIG. 1  portrays an example comprehensive remote monitoring system  10  for an indirect-flow, implantable left ventricular assist device (LVAD)  60 . The system may include a remote diagnostic device  20  that connects to the LVAD  60 , a remote server  70  and an end-user device  80 . LVAD  60  includes an inlet port that may be surgically positioned in the left ventricle of a patient&#39;s heart to receive oxygenated blood from the patient&#39;s lungs and an outflow port that may be surgically connected to the patient&#39;s aortic artery to conduit this blood to the patient&#39;s systemic circulation. LVAD  60  further includes an internal heart pump  62  to drive the flow of blood from the patient&#39;s lungs through the LVAD  60  to the patient&#39;s aortic artery. Depending on the particular configuration of the LVAD  60 , the internal heart pump  62  may comprise a rotating element supported with mechanical bearings, electromagnetic energy, or a combination thereof. 
         [0028]    The internal heart pump  62  is designed to communicate with the external environment through a driveline that exits the patient&#39;s body from an incision in the patient&#39;s chest wall to accommodate the receipt of electricity from an external power supply  66 . Depending on the configuration of the LVAD  60 , the power supply  66  may comprise one or more elements configured to produce the electricity that powers the internal heart pump  62 . Depending on the particular configuration of the LVAD  60 , the power supply  66  may comprise a battery that provide direct current electricity, a wall outlet or other source that provides alternating current electricity. 
         [0029]    The driveline also enables receipt of a motor control objective from an external heart pump controller  64 , which may, for instance, direct a rotating element of the internal heart pump  62  to rotate at a particular speed. In turn, the rotating element of the internal heart pump  62  may be configured to adjust its power consumption either up or down to maintain this predefined rotation speed despite changes in the patient&#39;s hemodynamic or physiological status that influence the environmental propulsion favorability. At least one computer-readable storage medium may store software comprising a set of program code instructions that, when executed, causes the heart pump controller  64  to continuously monitor power consumption by the rotating element of the internal heart pump  62  and to detect fluctuations that may occur over time. Moreover, the software may utilize a proprietary, machine-specific algorithm to estimate blood flow through the internal heart pump  62 . This algorithm can, for instance, be based on the known engineering principle that correlates power and speed to flow, the viscosity of the patient&#39;s blood that affects fluid dynamics, and motor design idiosyncrasies. 
         [0030]    As noted previously, the majority of LVADs do not utilize actual flow probes that are inserted in the implanted device due to the physiological problems such probes could cause. Instead, LVADs generate indirect flow measurements based on the machine-specific computational algorithms that report the flow rate variable based on its mathematical relationship of the known, observed variable of motor speed set by the operator and certain known patient physiological characteristics such as blood viscosity to the real-time power fluctuations of the machine (e.g., in terms of the wattage pulled by the machine from the battery or other power source) as it maintains a constant set speed under dynamic hydraulic conditions. The machine-specific algorithm referenced above may, in this regard, be derived by in vitro modeling of the functioning of a given LVAD using mock fluid loops that replicate the operation of the device in a fluid-filled, circulatory environment. Specifically, by establishing a computer connection to the LVAD, the data it generates when it is in communication with the internal pump component during dynamic activity in the mock loop can be collected, then software can be used to reconstruct the unique attributes of an LVAD&#39;s machine-specific algorithm that are based on how its proprietary motor(s) is designed to propel blood through the heart. This deduced algorithm can be used to indirectly measure blood flow through a given internal heart pump  62 . 
         [0031]    The diagnostic device  20  may be attached to the heart pump controller  64  through a compatible mechanical and electrical connector port  50 , which will be described in greater detail below in connection with  FIGS. 2A-2D and 3A-3D . As illustrated in  FIGS. 2A-2D and 3A-3D , the diagnostic device  20  is a portable and in some embodiments, hand-holdable, device that does not appreciably interfere with the controller&#39;s physical profile or with a patient&#39;s pre-existing mobility, activity level, or range of motion (it should be understood that in embodiments in which the heart pump controller  64  is configured to wirelessly transmit data in lieu of a diagnostic device  20  will not substantially affect the overall morphology of the heart pump controller  64  itself and thus will also not interfere with a patient&#39;s pre-existing mobility, activity level, or range of motion). Once connected to the heart pump controller  64  via connector port  50 , the diagnostic device  20  can receive data from the heart pump controller  64 . In some embodiments, this connector port  50  only allows data transfer in a downstream direction, such that data cannot be sent from the diagnostic device  20  to the patient&#39;s heart pump controller  64 ; preventing data from being uploaded to the patient&#39;s heart pump controller  64  in this fashion protects the integrity of the software employed by the heart pump controller  64  and, in turn, ensures that changes to the operating speed of the LVAD  60  can only occur with manual adjustment. However, in other embodiments it may be conceivable that the connector port  50  allows data to be transferred in both directions. For instance, the connector port  50  may include a user authentication feature (e.g., a biometric screening element or other secure identification mechanism) that allows data to be uploaded to the heart pump controller  64  by pre-authorized users. 
         [0032]    When the diagnostic device  20  receives data from the heart pump controller  64  via the connector port  50 , a bus within the diagnostic device  20  (e.g., LVAD data format interface and router  22 ) stores the data in a memory device  25 . Microprocessor  24  may remove patient-identifying information and may encrypt the data to protect health information before it is transmitted to a remote server  70  for analysis. 
         [0033]    After processing the data, the diagnostic device  20  may make the data accessible to additional devices. In this regard, the data can be transmitted using a wireless transmitter  28  and internal antenna  29 . The transmitter  28  may, in various embodiments, have the capability to transmit collected data using a wide variety of wireless transmission modes  30  (e.g., wireless communication modes such as radio communication, optical communication, sonic communication or the like). One example transmission may communicate data using special radio frequencies designated only for medical communications. It will be understood that while wireless transmission modes are contemplated herein and illustrated in  FIG. 1 , some example embodiments of the diagnostic device  20  may additionally or alternatively interact with remote devices (e.g., remove server  70 ) using wireline communication. 
         [0034]    The data that is retrieved by the diagnostic device  20  and transmitted to remote server  70  may include speed setting input, estimated instantaneous and average blood flow rate over a specified time interval, variable power consumption, indications regarding the incidence of any proprietary preprogrammed alarm notifications, or any other data that the LVAD  60  is configured to collect. Data transmission from the wireless diagnostic device  20  to a remote server  70  would typically be configured to occur continuously to facilitate the early identification of data trends that might require intervention. In an alternative configuration, however, diagnostic device  20  may be configured to transmit data periodically, on a scheduled basis, or in response to an ad hoc request initiated from the server  70 . 
         [0035]    While not true of all embodiments contemplated herein, the functions of the diagnostic device  20  may in some cases be supported by an integrated power supply  26 . The power supply  26  in such arrangements may be configured to receive power from the heart pump controller  64 , regulate it to compatible voltage, and allocate the power to the router  22 , processor  24 , and wireless transmission components  28  and  29 . 
         [0036]      FIG. 2A  depicts a long-axis, top-down view of diagnostic device  20 .  FIG. 2B  depicts the same device in long-axis side view, and  FIG. 2C  depicts the same side view with a downward tilt and medial rotation. As illustrated in  FIGS. 2A, 2B, and 2C , the diagnostic device  20  includes a posterior portion  30 . In some embodiments, the main enclosure of the electrical components  32  is composed of injection-molded plastic, although other materials may also be considered without departing from the spirit or scope of the present invention. 
         [0037]    The upper portion of the main enclosure  32  may include a faceplate  34  (which may, in some embodiments, be polycarbonate) with display sensor data lights that indicate various things. In some embodiments, the faceplate may include three display sensor data lights to indicate whether functioning contact exists between the heart pump controller and device (e.g., via display element  36   a ), whether there is active communication between the device and a remote network (via display element  36   b ), and whether a recent alarm has been received from the controller (via alarm display element  36   c ), respectively. In some embodiments, a communication disruption (either between the diagnostic device  20  and heart pump controller  64  or between the diagnostic device  20  and remote server  70 ) or the incidence of controller alarms may be indicated with a colored light (e.g., a red light). It should be understood that while alarm display element  36   c  may illustrate whether a recent alarm has been received from the controller of the LVAD  60 , in some embodiments, alarm display element  36   c  may additionally or alternatively illustrate whether an alarm condition is received from remote server  70 , as described below. In contrast, normal connection and internal heart pump  62  function may be indicated with a differently colored like (e.g., a green light). As mentioned previously, the diagnostic device  20  also includes a female connector port  50  (which may, for instance, be rubber) having a central recessed hole  52  surrounded by three symmetrically-arranged peripheral recessed holes  54 . Protecting the connector port  50  is an injection molded plastic shroud  40 . Shroud  40  may comprise a hub  44 , and central bevels  42  that twist into position to secure the contact points between the diagnostic device  20  and heart pump controller  64 .  FIG. 2D  displays the diagnostic device  20  in a short-axis frontal view, illustrating this hub and shroud configuration. 
         [0038]    An alternative embodiment of this diagnostic device is displayed in  FIGS. 3A-3D . These figures reproduce the same device enclosure  32 , display elements  36   a - 36   c , and plastic connector shroud  40  as displayed in  FIGS. 2A-2D , and in the same sequence of orientations.  FIG. 3D  displays the diagnostic device  20  in short-axis frontal view, portraying connector port  50 ′ that consists of two panels comprising a male and a female component. The superior portion of the panel is comprised of six pins  52 ′ and an inferior portion comprised of six recessed holes  54 ′. Accordingly,  FIGS. 2A-2D  differ from  FIGS. 3A-3D  only in that  FIGS. 3A-3D  illustrate a different connector port  50 ′ that enables the diagnostic device  20  can connect to and communicate with a different type of heart pump controller  64  that uses a different interface. Specifically, while the connector port  50  illustrated in  FIGS. 2A-2D  is configured to interface with the heart pump controller  64  of an HVAD system (manufactured by HeartWare), the connector port  50 ′ illustrated in  FIGS. 3A-3D  is configured to interface with the heart pump controller  64  of a HeartMate II LVAD (manufactured by Thoratec). However, it will be understood that while diagnostic device  20  has been illustrated in  FIGS. 2A-2D and 3A-3D  using these two particular types of connector ports  50  and  50 ′, other types of connector ports configured to interface with other heart pump controllers are contemplated without departing from the spirit or scope of the present invention. 
         [0039]    As noted previously, it should be understood that the capabilities of the diagnostic device  20  may in some embodiments be added to the heart pump controller  64  itself. In such embodiments, the heart pump controller may thus wirelessly transfer heart pump performance data without the need to connect to a separate diagnostic device  20  that acts as an intermediary. 
         [0040]    Once data has been transmitted by the wireless diagnostic device  20  (or, in embodiments in which the heart pump controller  64  itself is able to communicate wireless, once data has been wirelessly transmitted by the heart pump controller  64 ), it may be received by telecommunications hardware (e.g., antenna  71 ) of a remote server  70 . Once received by the server  70 , the data may be conveyed by a bus (e.g., data router  72 ) to the processor  74  for formatting and analysis, and stored in the memory device  77  of the server  70  for future retrieval and use. The data can be analyzed using a variety of bioengineering algorithms to calculate the performance characteristics of the internal heart pump  62 . 
         [0041]    For instance, in addition to remotely obtaining and monitoring LVAD flow characteristics as described above, this data can also be used to derive the difference in pressure between the outlet portion of the internal heart pump  62  in the patient&#39;s proximal ascending aorta and the inflow portion of the internal heart pump  62  in the patient&#39;s left heart chamber. As with the machine-specific algorithm referenced previously, machine-specific algorithms can illustrate pressure differences between the inlet port and outflow ports of the LVAD  60 . This pressure differential may be estimated, for instance, using the polynomial equations described in Table 2 in Salamonsen et al.,  Response of Rotary Blood Pumps to Changes in Preload and Afterload at a Fixed Speed Setting Are Unphysiological When Compared With the Natural Heart,  35 Artificial Organs E47, E49 (2011), the entire contents of which are incorporated herein by reference. Having access to this pressure difference variable is of great medical value because it represents a dynamic relationship between the heart and systemic circulation that changes according to the phase of contraction of the heart, the degree of constriction of the vasculature, and the current state of total body fluid balance. Depending on the particular software used and the configuration of adjunctive traditional non-invasive physiological measurements not specific to LVAD patients, the real-time state of total body fluid balance can be further deduced from the total pressure difference. Timely and frequent access to this information thus facilitates the judicious administration of medications to ensure that they are maintained in a healthy state of equilibrium. 
         [0042]    In addition, the data received by the remote server  70  may be conveyed via a communication network  400  (e.g., the Internet) to a modem  82  of an end-user device  80 . The end-user device  80  may be configured to present a graphical user interface (e.g., computer screen/interface application  100 ) to a user  90  for viewing the performance characteristics of the internal heart pump  62 . It should be understood that in some embodiments, the end-user device  80  may be the remote server  70 , and in such embodiments, the end-user device  80  need not retrieve data from the server  70  via a communication network  400 . 
         [0043]      FIG. 4  illustrates a flowchart containing a series of operations for analyzing data retrieved from an implanted artificial heart pump that indirectly measures flow. More specifically,  FIG. 4  provides a functional block diagram describing the analysis of data captured by the diagnostic device from the heart pump and the physiological variables that can be estimated with software applications. The data received from the internal heart pump  62  can be reconfigured and made available to the end-user  90  as a management decision-support tool with prediction capabilities. The operations illustrated in  FIG. 4  may, for example, be performed by, with the assistance of, and/or under the control of the devices utilized in comprehensive remote monitoring system  10 , which include LVAD  60 , diagnostic device  20 , server  70 , and end-user device  80 . 
         [0044]    In operation  402 , the heart pump controller  64  receives data representative of the fixed speed setting that is entered from the internal heart pump  62  and estimates the rate at which blood is flowing through the machine. As noted previously, given the dynamic nature of the motor&#39;s power utilization at a certain speed, the heart pump controller  64  can use a proprietary algorithm to perform this estimation. 
         [0045]    In operation  404 , a diagnostic device  20  connected to the heart pump controller  64  retrieves this data from the heart pump controller  64  and transmits it to a remote server  70  for analysis and further processing. As one aspect of this operation, the diagnostic device may remove patient-identifying information and/or encrypt the data to protect health information before the data is transmitted to a remote server  70  for analysis. It will be understood that in embodiments in which the heart pump controller  64  itself can wirelessly transmit data, operation  404  may instead be performed by the heart pump controller  64  itself. 
         [0046]    In operation  406 , the remote server  70  executes software (e.g., data analysis software  76 , which may be stored in memory device  77 ) to use the flow data to create real-time flow waveform graphs illustrating phasic waveforms including individual peaks and troughs representing the data retrieved from the LVAD  60 . It should be understood that the diagnostic device  20  is configured to transmit the retrieved data to the remote server  70  either prior to operation  406  or as an initial aspect of operation  406 . Moreover, it should also be understood that the remote server  70  may cache specific heart pump performance characteristics using a data storage device (e.g., memory device  77 ) for a specified period of time prior to overwriting. 
         [0047]    In operation  408 , the server  70  further executes software (e.g., software  76 ) to utilize the waveform amplitude morphology over time to estimate the pump flow pulsatility (a heart pump function variable that varies according to the amount of blood in the heart&#39;s left ventricle). 
         [0048]    In operation  410 , the server  70  further executes software (e.g., software  76 ) to derive the difference in pressure between the outlet portion of the internal heart pump  62  in the patient&#39;s proximal ascending aorta and the inflow portion of the internal heart pump  62  in the patient&#39;s left heart chamber. In some embodiments, the software can further use adjunctive traditional non-invasive physiological measurements not specific to LVAD patients to assess the real-time state of total body fluid balance for the patient by estimating the pressure in the patient&#39;s left heart during its relaxation phase before the beginning of each beat (a crucial physiological parameter that can be used to determine the medication regime required to optimize heart function and circulatory health). 
         [0049]    In operation  412 , the server  70  may further execute software (e.g., software  76 ) to estimate the pressure difference between the arterial pressure at the distal end of the internal heart pump  62  (e.g., at the outlet port) and the left ventricle pressure in the proximal end of the internal heart pump  62  (e.g., the inflow port) and thus arrive at an approximation of the patient&#39;s blood pressure during the different phases of the heartbeat. 
         [0050]    Finally, in operation  414 , after having estimated all of these cardiac indices, the server  70  may further execute software (e.g., software  76 ) to track the changing nature of the patient&#39;s cardiovascular status and anticipate the nature of support required to optimize the function of the heart pump. 
         [0051]    After analysis, the server  70  may locally store the processed data and analysis results or transmit the data and results to a centralized series of data services and data storage units for subsequent access by multiple end-users  90  with password clearance. In some embodiments, these end-users  90  may be located at off-site locations and who may thus access the data and/or analysis results via an Internet connection and modem  82 . These designated end-users  90  can retrieve this data via communication network  400  using a computer software application that further arranges the data visually on the screen in a format that is medically intuitive and will facilitate positive or negative trend recognition, as discussed in connection with  FIG. 5 . In other embodiments, end-users  90  may access the data and/or analysis results using server  70  itself (and in such embodiments, the server  70  may comprise the end-user device  80 , as noted previously. 
         [0052]    In some embodiments, if the data and/or analysis results fall outside of predefined thresholds (and in this regard, these thresholds may be previously identified by clinicians or may be based on similarities between the data or analysis results and historical data or analysis results known to be associated with poor patient outcomes), an alarm condition may be transmitted back to the diagnostic device  20 , which may in turn alert the patient to consult a clinician for a recommended course of action. Still further, such alarm conditions may additionally or alternatively be transmitted directly to medical professionals for immediate action (such as to prepare for the arrival of the patient at a medical facility or to dispatch responders to the patient&#39;s location for more immediate treatment or to communicate to the patient the nature of the alarm or any immediate clinical interventions that the patient can make unilaterally). As noted previously, the diagnostic device  20  (and/or heart pump controller  64 ) may include an element (e.g., alarm display element  36   c  or the like) configured to convey information regarding the alarm condition to the patient. 
         [0053]      FIG. 5  provides an illustration of a user interface provided by an example remote heart pump monitoring application that provides a visual dashboard for assessing data acquired from a heart pump that measures flow indirectly and patient-related physiological estimates. In some embodiments, an end-user may view this user interface using any suitable terminal (e.g., a fixed device such as a desktop, or a mobile device, such as a laptop, PDA, tablet, smartphone, or the like). The remote heart pump monitoring application may feature motion graphics and animation that includes a visual estimate of the instantaneous blood flow through the heart pump in liters per minute (L/min) per seconds of time (s)  110 , displayed in continuous waveform format  112  over a numerical grid  114  with a link to archival data  116  that provides statistical analysis of flow averages and identifies the instances in which flow values occurred outside of limit parameters stipulated by the end-user  90 . The application may also depict a continuous graph  120  of the relationship between the systemic arterial pressure  122  and the left ventricular pressure  124  estimates in millimeters of mercury (mmHg). The remote heart pump monitoring application may also provide a link to archived data  126 , including numerical trends. Another feature of the remote heart pump monitoring application may be a schematized drawing of a heart pump-cardiac unit  130  with movement depictions to represent blood flow and machine function and numerical display of the real-time estimates of the left ventricular volume  132  and flow through the pump  134 , and speed setting and power consumption  136 . In some embodiments, the remote heart pump monitoring application also includes additional links to particular patient-care related categories. For accessing additional useful patient information, the display may include a related grouping section  140  with a link to archived patient laboratory results  142 , medical history  144 , and cardiac diagnostic imaging and dynamic studies  146 . For urgent medical and engineering problems, the display may include a related grouping section  150  with a retrieval link to the local emergency medical services  152  and physician  154  and engineer  156  consultation. 
         [0054]      FIG. 6  illustrates a high-level system diagram in one example embodiment described herein. As shown in  FIG. 6 , implanted LVAD pump machinery that measures flow indirectly (e.g., internal heart pump  62 ) is connected through a driveline that exits the patient&#39;s body from an incision in the patient&#39;s chest wall to connect to an external heart pump controller  64 . In turn, a diagnostic device  20  may connect to the heart pump controller  64  and may wireless transmit data to a remote server (not shown), which may cause communication of a graphical interface providing the data and analysis results to an end-user in the form of a visual software application  100 . By virtue of the wireless connection provided by the diagnostic device  20 , this example embodiment facilitates the communication of data regarding the functioning of the implanted device to medical professionals and the ability to identify and react to abnormal indicators that would otherwise be undetectable outside of a medical facility. As a result, this example embodiment (and others described herein) greatly expands the oversight capability and more data-driven optimization of indirect flow measurement blood pumps without added interference with recipients&#39; quality of life or independence. 
         [0055]    As described herein, example embodiments of the present invention provide a system enabling the acquisition of data generated by implanted indirect flow measurement artificial heart pumps in an outpatient setting. Heretofore, this real-time data has been inaccessible to expert decision makers during the interval period that a patient is outside of a formal medical environment, but utilizing embodiments of the present invention, indirect flow measurements and other pump performance characteristics may now be remotely retrieved. Moreover, example embodiments enable the transmission of that data for expert review and provide software applications for characterizing pump performance using a visual display feature that depicts real-time estimates of the patient&#39;s circulatory status to assess physiological needs and promote positive long-term clinical outcomes. In turn, example embodiments of the present invention promote best-practice clinical decisions regarding heart pump use than currently exist for indirect flow measurement machines. 
         [0056]    It will be understood that although the above example embodiments are described in connection with a heart pump  62  that indirectly measures blood flow because indirect-flow devices represent the vast majority of heart pumps in use, other embodiments are also contemplated herein for remote monitoring of heart pumps that directly measure blood flow. In such embodiments, the structure and functions of the diagnostic device  20  parallel those of the example embodiments discussed above, with the caveat that the data conveyed wirelessly by the diagnostic device  20  is received from a different type of heart pump (with a similar caveat for embodiments where the heart pump controller is used in lieu of a diagnostic device  20  to perform this wireless conveyance). 
         [0057]    Many modifications and other embodiments of the inventions set forth herein will come to mind to one skilled in the art to which these inventions pertain having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is to be understood that the inventions are not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended claims. Moreover, although the foregoing descriptions and the associated drawings describe example embodiments in the context of certain example combinations of elements and/or functions, it should be appreciated that different combinations of elements and/or functions may be provided by alternative embodiments without departing from the scope of the appended claims. In this regard, for example, different combinations of elements and/or functions than those explicitly described above are also contemplated as may be set forth in some of the appended claims. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.