Portable medical device

Abstract

A patient-wearable treatment device comprising: Treatment elements connected to the treatment device and arranged near a skin of a patient (1); at least one patient movement detector (16; 17; 21; 31; 43; 52) connected to the treatment device and generating a signal indicative of an activity of the patient (1), wherein the at least one patient movement detector comprises at least one accelerometer (16; 17; 21; 31; 43; 52) mounted in the treatment device, wherein an output of the at least one accelerometer is stored in the treatment device; at least one controller (22; 32; 47; 54) for evaluating signals from the at least one accelerometer (16; 17; 21; 31; 43; 52) to determine whether the signal indicates an activity of the patient (1) that is appropriate for treatment, and based on the stored output of the at least one accelerometer, to monitor a state of congestive heart failure of the patient based on an activity level and the body position of the patient over a period of time; and a patient response sensor that can delay treatment when activated by the patient; and wherein treatment is initiated when the output of the at least one patient movement detector (16; 17; 21; 31; 43; 52) indicates a lack of patient activity and no input is received from the patient response sensor.

Description

Background of the invention

[0001] The wearable defibrillator consists of a monitor and a vest (or belt), both worn by the patient. The device monitors the patient's ECG using sensing electrodes such as 10a, 10b, 10c, and 10d to detect life-threatening arrhythmias and delivers a cardioversion or defibrillation shock via therapy pads such as 18 if treatment is needed.

[0002] There is also a third device, the battery charger, which can provide two functions: first, it can charge the monitor batteries 41, and second, it can provide a gateway for the monitor to download data to a central server. The monitor can communicate with the charger via a wireless Bluetooth connection, and the charger can connect to a central server via the Internet.

[0003] The accelerometer(s) can allow the computer in the wearable defibrillator to determine the position of the monitor, belt, and / or patient and the corresponding applied forces. This information can be used in a confidence-based arrhythmia detection algorithm to accelerate the timing and delivery of or withholding of therapy based on past and present body movement and / or positional history.

[0004] Other devices that could be used instead of an accelerometer include, but are not limited to: gyroscope, magnetometer, Hall effect devices, and other force, motion, or position sensors.

[0005] US 5,472,453 A describes an implantable medical interventional device, e.g. a pacemaker, cardioverter, defibrillator or a device with a combination of such functions, wherein an activity sensor, e.g. an accelerometer, is provided which, upon detecting a physical activity, prevents the device from delivering an antitachycardia treatment.

[0006] US 2006 / 0 270 952 A1 discloses a resuscitation device for assisting or training a rescuer in resuscitating a patient. The device includes a handset configured to be placed on the patient's chest during resuscitation, and the user presses on the device to apply compressive force to the patient's chest. The device includes an accelerometer to measure the acceleration of the patient's chest and estimate chest displacement from the measured data. SUMMARY OF THE INVENTION

[0007] The present invention consists in a treatment device portable by a patient as defined in claim 1.

[0008] Accelerometers can measure x, y, and z positions. This improvement includes the presence of an accelerometer either in the belt worn on the patient's upper body or in the monitor worn on the patient's lower body; or in both locations; or other positions on the patient.

[0009] The accelerometer in the belt can be used to determine patient position, as it is located on the patient's torso. Consequently, the belt accelerometer is selected so that high-sensitivity data can be measured or determined from possible body positions (e.g., patient position). The accelerometer in the monitor can be selected to measure high-sensitivity data (such as breathing or other slight movements), low-sensitivity data (such as a mechanical shock), or both. Additional accelerometers can also be used so that both low-sensitivity and high-sensitivity data can be measured, or an accelerometer can be used that can have both low and high sensitivity.

[0010] Some embodiments of the invention include a treatment device wearable by a patient, having treatment elements adjacent to the patient or in proximity to the patient's skin, and at least one detector for detecting patient movement, connected to the device and generating a signal indicative of patient activity, and at least one controller for evaluating signals from the movement detector to determine whether the signal indicates patient activity appropriate for treatment.

[0011] Embodiments include using at least one accelerometer, which includes at least one multi-axis accelerometer and may include two three-axis accelerometers, where one of the accelerometers is mounted on a patient vest portion and the other of the accelerometers is mounted at the monitor or another portion. Some embodiments may include a visual display on the monitor portion, where the orientation of the visual display is controlled by the output of the accelerometer.

[0012] The patient's body orientation, including standing and leaning orientation, is determined by the output of at least one accelerometer.

[0013] A treatment can be accelerated or delayed depending on the output of the motion detector.

[0014] The invention can detect a patient's condition depending on the patient's activity level over a period of time based on the stored output of the accelerometer and can be used to detect conditions such as congestive heart failure or pathological sleep disorders.

[0015] A method for cardiac treatment of a patient is described, which includes detecting a cardiac condition, detecting the patient's movement with sensors, such as accelerometers, worn by the patient, and evaluating the detected patient activity to determine whether treatment is appropriate for the cardiac condition.

[0016] Embodiments can detect vertical and inclined positions and can determine a patient's activity and a patient's body orientation.

[0017] The following is a list of the functions and information that can be provided by detecting movement or by accelerometers: Patient's body condition: the patient is vertically aligned, the patient is horizontally aligned (on the left side, on the right side). Patient moves with repetitive patterns: vibrating (environmental), spasmodic Patient is accelerated: the patient falls. State of the device (belt and monitoring device): x / y / z position. Acceleration of the device. Mechanical shock to the device (high force impact, acceleration). Verification of a palpable motor activity in a knot device of the belt. Short description of the drawings Fig. Figure 1 schematically shows the positioning of an accelerometer in certain embodiments with cardiac sensors and treatment electrodes. Fig. 2 is a block diagram of an embodiment employing two accelerometers. Fig. 3 is a schematic block diagram of an embodiment in which an accelerometer is used in a monitoring device. Fig. 4 is a block diagram of an embodiment in which an accelerometer is used in a knot device of the belt. Fig. 5 is a logic diagram of an algorithm that may be used in an embodiment of the invention. Description of some embodiments of algorithms and methods for using information

[0018] Fig. 1 shows a patient 1 with a wearable defibrillator. Typically, the illustrated devices are worn as a vest, a belt, and / or in the form of other clothing. In this embodiment, four sensing electrodes 10a, b, c, d or sensors are illustrated. While this embodiment is suitable for cardiac monitoring and treatment, other medical functions may also be suitably monitored or treated. In this embodiment, a node device 11 is used, and the sensors 10a, b, c, d and treatment devices 18 are connected to the node device. The node device 11 may be disposed on the belt or at other locations on the patient. The therapy pads or treatment devices 18 provide treatment when a detected condition indicates a preferred treatment.

[0019] Any motion sensor can be used. The currently preferred embodiment uses accelerometers. Such sensors indicate accelerated movements. Since human movements generally involve short distances and short durations, accelerometers provide a very good indication of a patient's movement. Single-axis as well as multi-axis accelerometers can be used.

[0020] In this embodiment, two accelerometers 16, 17 are employed. One accelerometer 17 is located on the node device 11, and a second 16 is employed at the monitoring device 15. It should be understood that some embodiments utilize a single accelerometer or position / force / motion detector, and other embodiments may utilize three or more. The use of multiple sensors allows the treatment algorithm to evaluate differences in the accelerometers to predict patient activity and accelerometer reliability. The use of multiple accelerometers allows for self-assessment of various patient movements and comparison of such self-movements to best determine patient activity and device function.The treatment algorithm currently used usually depends on the diagnostic requirements of each individual physician and the conditions they wish to monitor. Any or all of the activities determined by the invention can be used. This can be combined with other inputs.

[0021] Fig. Figure 2 shows a block diagram of a device in which the accelerometer and a microcontroller are housed on the patient 1, a wearable vest, or a belt. The vest-worn devices can communicate via a cable or wireless communication link with a monitoring device containing a second accelerometer 31. Each accelerometer 21, 31 can indicate the corresponding movement of its position of the patient and / or can be used in an algorithm that uses the combined signals to more reliably indicate patient activity. Processing of accelerometer data can be performed by the microcontroller 22 in the node device 20 of the belt or vest, or by a system computer 32 present in the monitoring device 30, or at both processing locations.Accelerometers 21, 31 indicate a change in velocity. Conscious patients typically have an activity level that includes changes in both velocity and direction. In contrast, changes in body movement are absent in an unconscious patient. Other sensors, such as gyroscopes, can be used with appropriate software to indicate movement or lack of movement.

[0022] Outputs from sensors can be summarized, compared, or subtracted to best predict patient activity and reduce interference or error signals. Patient movement during cardiac arrhythmia

[0023] Accelerometers can be used to determine the state of a patient's body during the detection of a cardiac arrhythmia. They can also be used to determine whether a mechanically disturbing environment has caused a false detection of a cardiac arrhythmia. Patient movement for use in an algorithm to determine a confidence factor

[0024] An algorithm for determining a confidence factor, which is influenced by many inputs including the patient's body condition as determined by the accelerometers, is used to determine whether a patient's cardiac arrhythmias require defibrillation.

[0025] Generally, cardiac treatment is not required if the patient is conscious. By using accelerometers, the patient's physical condition can be monitored. If there has been no change in the patient's physical condition as detected by the accelerometer(s) over a period of time, then there is increased confidence for the algorithm that the patient is unconscious. If a change in the patient's physical condition has been detected by the accelerometer(s), then there is decreased confidence for the algorithm that the patient is unconscious. The wearable defibrillator can accelerate the decision to administer treatment when there is a high level of confidence that the patient is unconscious.If patient movement is detected while other sensors and algorithms indicate that a treatable rhythm is present, treatment may be delayed to give the patient additional time to respond to a system notification. Incorrect detection of a cardiac arrhythmia due to a body movement

[0026] Occasionally, a false arrhythmia is detected due to physical movement—i.e., the movement of an electrode or cables relative to the body or clothing—which produces false deviations in the patient's ECG. If an arrhythmia is detected and a vibration or high acceleration of the patient or device is detected, the patient can be alerted to this condition. The tactile stimulator can be turned on or its volume increased to notify the patient. This information can also be used by the treatment confidence algorithm to lower the confidence, given that physical movement can cause a false positive detection. The use of the accelerometer(s) can prevent unwanted treatment of a false arrhythmia. Correlation of an ECG artifact with belt movement

[0027] Movement of the electrode belt can cause interference with a recorded ECG signal and potentially lead to false detection. The signals obtained from the accelerometer can be correlated with an ECG signal to determine if there is any impairment of the ECG signal. The quality of the correlation can be used as an additional confidence factor in the arrhythmia detection algorithm. If an arrhythmia is detected and there is a high correlation between the ECG signal and the accelerometer signal, the confidence in detecting the arrhythmia can be reduced. A lack of signal correlation indicates increased confidence that the arrhythmia detection is correct. Treatment verification

[0028] Accelerometers can also be used to verify that treatment has been administered by detecting sudden movements and muscle spasms that occur in a patient immediately after treatment. Often, after defibrillation, a patient's muscles spasm due to the energy pulse. These muscle spasms result in detectable movements on the accelerometers, similar to what happens with convulsions. Bystander detection / / Unsuccessful defibrillation

[0029] Movement of the patient after a shock following several unsuccessful defibrillation attempts may indicate the presence of bystanders. These bystanders could be emergency personnel, such as paramedics. In this case, special alarms or voice messages can be generated to inform bystanders about the device and the treatment status. Additional shocks can be delayed or aborted to prevent shocks from being delivered to bystanders or emergency personnel. Detection of movement after a shock

[0030] After a shock has been delivered, the patient may move suddenly and then return to a state of no movement. If no further movement is detected, there may be a high degree of confidence that the cardiac arrhythmia is still present. This information can be used as an additional post-shock confidence factor for the detection algorithm and that an abnormality is still present. If movement continues after a shock, or if the patient's body position changes from a horizontal to a vertical position, there is a high degree of confidence that defibrillation was successful, and additional shocks can be delayed. Feedback on the quality of the belt

[0031] The overall quality of the belt can be verified by collecting data using the accelerometers during certain fault conditions, such as detecting an electrode drop or a therapy pad drop. Preventing electrode and therapy pad from falling off

[0032] If one of the electrodes 10 or therapy pads 18 falls off the patient, the system records the patient's body condition during the fall. Patient positions include sitting up, lying down, left side, and right side. If a vibration or a fall of the patient is detected, this is also recorded, as this may have caused the fall.

[0033] The data can be analyzed over time and used to determine positions that may be prone to dropping. This information can then be used to improve the belt design to reduce or potentially eliminate dropping in those specific activities or positions.

[0034] For example, subsequent analysis of data over a period of several months might show that 75% of drop events occur when the patient is lying on their left side, in which case the design of the belt could be reviewed with respect to the left side to determine what makes it prone to drop occurring with the patient in this position. Providing recommendations for patients

[0035] Accelerometer data collected over time can also be used to inform new patients about body postures that tend to be more comfortable. Patients who have worn the device for an extended period of time have likely tried different positions (sleeping, sitting, etc.) and tend to use the most comfortable ones. This data can be recorded and used to improve the belt for other positions and also to provide recommendations for new patients. Improved belt comfort

[0036] The accelerometer data collected during use on a patient can be used to improve the comfort of the belt by studying the patient's sleeping habits or habits during other selected activities.

[0037] If 80% of patients tend to sleep on their right side, then it's reasonable to assume that something about the belt makes it less comfortable for patients to lie on their left side. With this information, research can be conducted to determine what it is about this position that makes the belt uncomfortable, and constructive efforts can be made to improve belt comfort. Self-diagnosis of the belt

[0038] A self-diagnosis, such as a (vibration / acceleration) self-test of a tactile stimulator of a knot device of a belt can also be provided.

[0039] The tactile stimulator 12 (a notification device for the patient) is a motor with an unbalanced weight on its shaft. When the motor is switched on, it causes the belt to vibrate, similar to a mobile phone in vibration mode.

[0040] When the tactile stimulator is activated, the accelerometer 17 can be inserted into the node device to check whether the node device vibrates, which means that the tactile stimulator is working. Notification of the patient about physical processes

[0041] Accelerometers can be used to provide the patient with feedback regarding certain mechanical processes. They can also be used to adjust the volume of the device depending on the patient's current condition. Notification of misuse of the device

[0042] If certain mechanical conditions that may result in damage to the device, such as mechanical shock or vibration, are detected by the accelerometers, the system may notify the patient of such conditions and inform the patient of the condition via the computer screen of the monitor 15.

[0043] If the monitor or belt falls or collides with any other object resulting in a force greater than a predefined acceptable force, the monitor will provide either an audible or a visual (display) indication to the patient that this event has occurred and a warning against allowing such an incident to occur again.

[0044] If sustained vibration above a certain predefined acceptable threshold is detected over a period of time, the monitoring device 15 can also provide a warning to the patient. Such vibration may cause an electrode or therapy pad to detach, or may even lead to false detection of a cardiac arrhythmia if sufficient physical movement is applied to the electrode and cable. Setting the alarm strength of the device

[0045] If the accelerometers have recorded that the patient's physical condition has not changed for an extended period of time and the patient is either lying down or sitting, the monitor assumes the patient is asleep and increases the volume of any audio message if necessary to awaken the patient. The monitor can also enable the tactile stimulator to awaken the patient in the event of a critical audio message. Setting a display rotation

[0046] The monitor's accelerometer can also be used to determine the correct rotation of the system display or LCD output at 15. The monitor 15 includes a display that can be used either to output a visible message to the patient or to facilitate initial patient setup by caregivers. Since the monitor is located approximately in the midline of the patient, the display for visible messages to the patient would be positioned upside down (rotated 180 degrees) with respect to the monitor. Conversely, during patient setup, the monitor could be held right-side up in front of the trained personnel. Thus, the display would be positioned right-side up.The accelerometer data from the monitor can be used to adjust the display depending on how the display is attempted to be read. Detecting misuse of the device

[0047] Misuse of the device during use as well as during transport can be detected. Misuse of the device can be determined by parameters such as how often it has been dropped and how severely. Detecting misuse of the device can trigger actions such as an internal review, automatic download, or service notifications for the device. Detecting a fall of the device

[0048] If the accelerometers detect a mechanical shock above a predetermined acceptable threshold, the monitor records a drop event. Other parameters, such as the date / time stamp and current operating mode, are also recorded.

[0049] The date / time stamp should allow for a correlation between the location of the monitoring device and the damage to the device and the damage process, allowing further information to be obtained using the carrier's tracking numbers if such damage occurs during transport.

[0050] If it doesn't occur during transport and during patient use, and some form of device malfunction occurs after being dropped, this could lead to the cause of the device failure. Such information could be used to educate patients about the types of mechanical shocks that can damage the device. It can also be used to improve the device's stability to withstand such forces in the future. Service recommendation for the device

[0051] If the monitor's accelerometer 16 or the belt's accelerometer 17 have recorded a mechanical shock above a predefined acceptable threshold, or if a predefined acceptable number of mechanical shocks has occurred, the monitor will advise the patient that the device should be serviced with an audible or visible (display) message above 15. The monitor 15 can also notify the manufacturer that it needs service during the next download. Internal diagnostics

[0052] If the accelerometer detects excessive mechanical shock to the belt or monitoring device, it can initiate an internal self-diagnosis. Both the monitoring device 15 and the node device 11 have built-in circuitry, as described in Fig. 3 and Fig. 4 to allow most of its components to be tested by self-diagnosis. Automatic download to the manufacturer

[0053] If a major mechanical shock occurs to the belt or monitoring device, the monitoring device can immediately initiate an automatic download to the manufacturer to request maintenance. Monitoring patient activity over time

[0054] Accelerometer data can be measured and the time recorded to study a patient's activity. The patient's activity data can be used to provide physicians with feedback about a specific patient condition. Data of a patient's activity and treatment

[0055] After a treatment procedure, data regarding the patient's activity occurring before and during the procedure, including the procedure itself, can be downloaded. This data can be collected from patients and used to establish correlations between patient activity derived from accelerometers 16, 17 and the likelihood of a potential treatment procedure occurring. These correlations can be used to implement protective measures against patients who exhibit similar activities to those who have experienced treatment procedures in the past. Data of a patient's activity and feedback to the doctor

[0056] Patient activity data can be used by physicians or data analysis systems over time to determine whether adequate levels of patient activity exist. Examples of review would include extremely low patient activity; the patient's performance of recommended exercises; and / or a real-time patient activity level with corresponding heart rate data. Patients experiencing congestive heart failure can be monitored for physical activity and resting posture. A gradual decrease in patient activity, indicated by a lack of movement, may indicate a worsening of congestive heart failure.Resting posture may also indicate deterioration of the patient if resting posture is primarily vertical, as patients with cardiac decompensation have difficulty resting in a horizontal position.

[0057] Fig. Figure 1 shows the position of the accelerometers 16, 17 relative to the patient and other components of the system. The accelerometer 16 located at the front is the monitor accelerometer. The accelerometer located at the rear is the belt node accelerometer 17. The connecting cable 13, in this embodiment, enables communication between the belt node computer and the main monitor computer. This allows data to be transferred from the belt node accelerometer to the main monitor computer 47. Furthermore, the connecting cable 13 allows the monitor power connectors 41, 51 to be used to power the belt node computer and peripheral devices.The two accelerometers or motion detectors allow the system to determine parameters such as the patient's body position, movement, and acceleration, as well as perform certain system self-diagnostics. The monitoring device can contain either a high-G or a low-G accelerometer. A high-G accelerometer with low sensitivity would also allow the system to detect a physical shock to the patient or device.

[0058] Fig. Figure 3 illustrates the circuitry used to receive data from the accelerometer 43 in the monitoring device (15 at Fig. 1). Voltage regulators 42 are used from the main battery 41 to supply the electronics with the required voltages. The computer 47 controls various system parameters, such as accelerometer sensitivity, channel selection of the multiplexer (MUX) 45, the analog-to-digital converter (ADC) 46, and serial communications. The micro-engineered, three-axis, low-g accelerometer from Freescale Semiconductor MMA7260Q can be used. The g selection control line between 47 and 43 allows the sensitivity to be varied from, for example, 1.5 g to 6 g. A high-g, low-sensitivity accelerometer can also be used instead of the MMA7260Q. This could allow a patient / device shock to be detected.A resistor-capacitor (RC) filter 44 can be used on each accelerometer output to minimize clock noise from an internal switched-capacitance filter circuit. The select lines of MUX 45 can be controlled by computer 47 and can allow the output of each axis of the accelerometer to be switched to the input of ADC 46. ADC 46 can also be controlled by computer 47 via a serial interface.

[0059] Fig. Figure 4 is a block diagram illustrating the circuitry that may be used to receive data from the accelerometer 52 at the node device (11 in Fig. 1) of the belt. Power supplies and voltage regulators 51 derived from the monitoring device can be used to power the electronics in the belt's node assembly. The micro-scale, three-axis, low-g accelerometer 52 from Freescale Semiconductor can be used. The belt's node assembly computer 54 controls the g-select lines, which in turn allows the sensitivity to be varied from 1.5 g to 6 g. RC filtering as well as amplitude scaling 53 can be used on each of the accelerometer outputs. An internal MUX and ADC in the belt's node assembly computer 54 allow the accelerometer's analog output to be passed directly to the computer in digital form.

[0060] An algorithm for detecting cardiac arrhythmia can be implemented by assigning different confidence coefficients or weighting values ​​to the various detectors used by the algorithm. This can be done before the confidence algorithm is applied for motion detection. For example, the monitoring device can be designed to analyze two independent ECG data streams. The algorithm can, for example, execute independent algorithms on each data stream, analyzing the signal for heart rate, morphology, frequency information, and other information. An additional analysis is performed independently for each channel to analyze the signal for noise interference, which may result from patient movement or from biological signals such as muscle noise.Other secondary inputs related to the basic acquisition algorithm may include a patient response button and inputs from the accelerometers.

[0061] Each detector can be assigned a weighting value, and the response button and accelerometer, and the combination of all detectors, can be configured to determine whether a treatable cardiac arrhythmia exists. Furthermore, the weighting values ​​can be used to manipulate the timing of therapy delivery.

[0062] Implementing the algorithm in the presence of a noisy ECG channel could involve placing more emphasis on the heartbeat detector in the error-free ECG channel. For the accelerometer algorithm with an improved confidence value, a weight could be assigned that would delay the delivery of a treatment while detecting patient movement, as shown in the flowchart in Fig. 5 is shown.

[0063] The flow chart in Fig. Figure 5 shows that if patient movement is detected before a treatable cardiac arrhythmia is detected, the timing of treatment delivery can be altered depending on the inputs from the accelerometers 16, 17 when the cardiac arrhythmia is detected. If patient immobility coincides with the detection of the cardiac arrhythmia, there is increased confidence that the diagnosis of a cardiac arrhythmia is correct and that treatment delivery can be made sooner. If movement continues after the detection of a cardiac arrhythmia, the confidence of a valid detection may be reduced, since fatal cardiac arrhythmias usually result in loss of consciousness. In this case, treatment delivery can be delayed to allow time for audible voice messages to prompt the patient to respond by pressing the response button.The response button provides a responsiveness test input for the algorithm. In some embodiments, it may be desirable to never deliver a shock to a conscious patient. This algorithm can reduce the likelihood of incorrect treatment due to an invalid diagnosis of a cardiac arrhythmia caused by erroneous ECG inputs caused by excessive patient movement or other environmental factors.

[0064] Fig.Figure 5 illustrates how a typical algorithm detecting a cardiac arrhythmia can have increased confidence by serially executing a subsequent confidence algorithm using inputs from a motion detector or accelerometer(s). Other motion detecting devices or confidence algorithms may use different motion detecting criteria, as desired by clinicians, depending on the treatable condition, and the patient.

[0065] Typically, it is desirable to track and store the data in the device worn by the patient, with additional storage, tracking, and evaluation of movement data. One possible application would be to evaluate past movement and activity levels to detect conditions such as congestive heart failure.

[0066] Such diseases are often found in patients who wear a cardiac treatment device.

Claims

[1] A treatment device portable by a patient, comprising: Treatment elements connected to the treatment device and arranged near a skin of a patient (1); at least one patient movement detector (16; 17; 21; 31; 43; 52) connected to the treatment device and generating a signal indicative of an activity of the patient (1), wherein the at least one patient movement detector comprises at least one accelerometer (16; 17; 21; 31; 43; 52) mounted in the treatment device, wherein an output of the at least one accelerometer is stored in the treatment device; at least one controller (22; 32; 47; 54) for evaluating signals from the at least one accelerometer (16; 17; 21; 31; 43; 52) to determine whether the signal indicates an activity of the patient (1) that is appropriate for treatment, and based on the stored output of the at least one accelerometer, to monitor a state of congestive heart failure of the patient based on an activity level and the body position of the patient over a period of time; and a patient response sensor that can delay treatment when activated by the patient; and wherein treatment is initiated when the output of the at least one patient movement detector (16; 17; 21; 31; 43; 52) indicates a lack of patient activity and no input is received from the patient response sensor. [2] A portable medical device comprising: Treatment elements connected to the portable medical device and arranged near a skin of a patient (1); Cardiac measuring electrodes (10a, 10b, 10c, 10d) designed for external placement in close proximity to a patient in order to collect cardiac information from the patient; at least one motion detector (16; 17; 21; 31; 43; 52) designed for external placement in close proximity to a patient to detect a movement of the patient and a body position of the patient; a monitoring device connected to the at least one movement detector (16; 17; 21; 31; 43; 52) and the cardiac measuring electrodes (10a, 10b, 10c, 10d) and configured to detect the movement and body position of the patient over a period of time, detect changes in the degree of movement and body position of the patient over the period of time, and determine whether the changes in the degree of movement and / or body position of the patient over the period of time are indicative of congestive heart failure; a patient response sensor that can delay treatment when activated by the patient; and wherein treatment is initiated when the output of the at least one patient movement detector (16; 17; 21; 31; 43; 52) indicates a lack of patient activity and no input is received from the patient response sensor. [3] Device according to claim 1 or 2, characterized bythat the at least one detector for a movement of the patient comprises at least one accelerometer (43; 52) with several axes. [4] Device according to claim 3, characterized by in that the at least one patient movement detector comprises at least two three-axis accelerometers (43, 52), one of the at least two accelerometers (43) being mounted on a portion of a patient's vest (1); and another of the at least two accelerometers (52) being mounted on a monitoring device. [5] Device according to claim 4, characterized by that the activity level and / or the body position of the patient (1) are determined from the output of one of the at least two accelerometers (16; 17; 21; 31; 43; 52) which is attached to the area of ​​the patient's vest. [6] Device according to claim 5, characterized bythat the body position of the patient (1) includes a vertical standing orientation and an inclined orientation. [7] The device according to claim 1, further comprising cardiac measuring electrodes (10a, 10b, 10c, 10d) connected to the treatment device, wherein the cardiac measuring electrodes are arranged in proximity to the skin of the patient. [8] The apparatus of claim 1 or 2, further comprising a treatment algorithm, wherein a treatment is accelerated or delayed by the algorithm based on the output of the motion detector. [9] The device of claim 8, further comprising: a stimulator alarm that provides a patient stimulus after a cardiac condition is detected and before treatment is initiated. [10] Apparatus according to any one of the preceding claims, adapted to provide the activity level and body position sensed over the period of time to determine patient deterioration in a patient with congestive heart failure based on at least the resting position of the patient's body. [11] Apparatus according to any preceding claim, adapted to provide the activity level and body position sensed over the period of time to determine whether the patient activity data indicates a decrease in patient activity over time. [12] Apparatus according to any preceding claim, adapted to provide the activity level and body position sensed over the period of time to determine whether the patient activity data is indicative of worsening congestive heart failure. [13] The apparatus of claim 2, further comprising storing the output of said at least one motion detector in said apparatus. [14] The device of claim 2, wherein the volume of an audio notification to the patient is increased when an unchanged body condition is detected over a period of time. [15] The apparatus of claim 2, wherein the monitoring device is configured, in response to detecting that the amount of movement of the patient has decreased over the period of time, to determine that the changes in the amount of movement and / or the body position of the patient detected over the period of time are indicative of congestive heart failure. [16] The apparatus of claim 2, wherein the monitoring device is further configured to determine, in response to detecting that the patient's body position has become more vertical over the period of time, that the changes in the amount of movement and / or the patient's body position detected over the period of time are indicative of congestive heart failure. [17] The apparatus of claim 2, wherein the monitoring device is further configured to determine, in response to detecting that over the period of time the amount of movement of the patient has decreased and the body position of the patient has become more vertical, that the changes in the amount of movement and / or the body position of the patient detected over the period of time are indicative of congestive heart failure. [18] The treatment device of claim 2, wherein the medical device further comprises at least one defibrillation electrode configured for external placement in close proximity to the patient to provide defibrillation treatment to the patient.

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