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Adaptive servoventilation in clinical practice: beyond SERVE-HF?
Winfried Randerath1,2, Katja Schumann1,2, Marcel Treml1
1Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany.
ERJ Open Research
|December 6, 2017
Summary
Adaptive servoventilation (ASV) effectively treats sleep breathing issues. However, the SERVE-HF trial restricted its use; this study found few ASV patients meet those strict criteria, with low mortality in the identified risk group.
Area of Science:
- Sleep Medicine
- Cardiology
- Respiratory Medicine
Background:
- Adaptive servoventilation (ASV) is effective for sleep-related breathing disorders.
- The SERVE-HF trial led to restrictions on ASV use.
- Real-world clinical relevance of SERVE-HF criteria needs evaluation.
Purpose of the Study:
- To assess the clinical relevance of SERVE-HF inclusion criteria in real-world ASV patients.
- To determine the proportion of ASV patients meeting SERVE-HF criteria.
- To analyze outcomes for ASV patients with and without risk factors.
Main Methods:
- Retrospective study of 293 ASV patients (1998-2015).
- Reviewed cardiovascular disease history, LVEF, and polysomnography data.
- Identified patients meeting SERVE-HF inclusion criteria.
Main Results:
- 87.0% had cardiovascular diseases; 40.3% had heart failure (HF).
- Only 16.0% of HF patients had LVEF ≤45%; 4.1% had LVEF <30%.
- SERVE-HF criteria applied to 9.6% of patients; 3 deaths occurred in the high-risk subgroup (LVEF <30%).
Conclusions:
- A small minority of ASV patients meet the restrictive SERVE-HF criteria.
- Mortality in the identified high-risk group did not exceed expected rates for optimally treated systolic HF.
- ASV may be safely used in carefully selected patients outside the strict SERVE-HF criteria.
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