Efficacy of Adaptive Servo-Ventilation in Worsening Heart Failure

Despite advancements in heart failure (HF) therapies, managing symptoms and congestion remains challenging for some patients. Adaptive servo-ventilation (ASV) has been used in Japan to treat residual congestion in chronic HF, but its efficacy remains debated.This study is a subanalysis of the SAVIOR-L study, a multicenter prospective observational study in Japan evaluating ASV in worsening HF. The study included 96 ASV users (ASV group) and 288 non-ASV users (non-ASV group) selected via propensity score matching. The primary outcome was a hierarchical composite of cardiovascular death and cardiovascular-related hospitalization, assessed using a win ratio analysis.The win ratio (95% CI) for ASV was 0.838 (0.657-1.069) in the matched-pair method and 0.850 (0.829-0.872) in the unmatched-pair method. Furthermore, the results of the win ratio analysis using the matched-pair method remained consistently neutral even in stratified analyses based on heart failure severity.The results indicate that ASV use in worsening HF has a neutral effect on prognosis. While ASV does not appear to be definitively harmful, its benefits remain uncertain. Therefore, its use requires careful consideration in clinical practice.