Universität zu Köln

Javaheri, Shahrokh, Brown, Lee K., Randerath, Winfried and Khayat, Rami (2016). SERVE-HF: More Questions Than Answers. Chest, 149 (4). S. 900 - 905. AMSTERDAM: ELSEVIER SCIENCE BV. ISSN 0012-3692

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Abstract

The recent online publication of the SERVE-HF trial that evaluated the effect of treating central sleep apnea (CSA) with an adaptive servoventilation (ASV) device in patients with heart failure and reduced ejection fraction (HFrEF) has raised serious concerns about the safety of ASV in these patients. Not only was ASV ineffective but post hoc analysis found excess cardiovascular mortality in treated patients. The authors cited as one explanation an unfounded notion that CSA is a compensatory mechanism with a protective effect in HFrEF patients. We believe that there are several possible considerations that are more likely to explain the results of SERVE-HF. In this commentary, we consider methodological issues including the use of a previous-generation ASV device that constrained therapeutic settings to choices that are no longer in wide clinical use. Patient selection, data collection, and treatment adherence as well as group crossovers were not discussed in the trial as potential confounding factors. We have developed alternative reasons that could potentially explain the results and that can be explored by post hoc analysis of the SERVE-HF data. We believe that our analysis is of critical value to the field and of particular importance to clinicians treating these patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Javaheri, Shahrokh UNSPECIFIED UNSPECIFIED UNSPECIFIED Brown, Lee K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Randerath, Winfried UNSPECIFIED UNSPECIFIED UNSPECIFIED Khayat, Rami UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-279263
DOI:	10.1016/j.chest.2015.12.021
Journal or Publication Title:	Chest
Volume:	149
Number:	4
Page Range:	S. 900 - 905
Date:	2016
Publisher:	ELSEVIER SCIENCE BV
Place of Publication:	AMSTERDAM
ISSN:	0012-3692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CENTRAL SLEEP-APNEA; POSITIVE AIRWAY PRESSURE; CONGESTIVE-HEART-FAILURE; VENTILATION; SMOKING; ALKALOSIS; MORTALITY; MORBIDITY; DESIGN; RISK Multiple languages Critical Care Medicine; Respiratory System Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27926