A system and method for determining a stressor-based reference baseline for use in heart failure assessment is presented. A patient is monitored during an observation time period while the patient performs prescribed physical stressors and by applying pacing stimulus stressors to a medical device. Physiological measures are stored from the observation period, including at least one of direct measures regularly recorded on a substantially continuous basis by the medical device and measures derived therefrom. The measures that originate from the observation time period as a reference baseline for the patient are identified. The reference baseline and those measures originating subsequent to the observation period are evaluated. The measures are analyzed to detect any trends, including one of a status quo and a change in cardiac performance of the patient. Each trend is compared to parameters corresponding to worsening heart failure indications to generate a notification of parameter violations.
