SERVE-HF was the first long-term randomised, controlled, international, multicentre study designed to assess the effects of adaptive servo-ventilation (ASV) on morbidity and mortality in patients with symptomatic chronic heart failure (HF) with reduced left ventricular ejection fraction ((LVEF ≤ 45%) and predominant central sleep apnoea-Cheyne-Stokes respiration (CSA-CSR).
The SERVE-HF intention-to-treat analysis1 showed that ASV had no effect on the primary endpoint: composite of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalisation for heart failure (HF).
The cardiovascular death risk observed in SERVE-HF has been confirmed as a true clinical finding.2
The mortality risk seen in SERVE-HF was seen only in patients with systolic heart failure and predominantly central sleep apnoea.3
The SERVE-HF additional analysis has confirmed that observed mortality risk occurs in patients with LVEF<45% and that the harmful effects of ASV correlate with pre-existing LV systolic impairment.3
ASV does not seem to worsen LV function.4
The mortality risk seen in SERVE-HF is unrelated to the magnitude of the PAP delivered.5
We can therefore conclude that, in the presence of significant LV dysfunction and predominantly central sleep apnoea, ASV may become a harmful intervention. People with enlarged and weakened left ventricles are a particularly vulnerable group, some of whom may also be at risk of sudden cardiac death from co-existing arrhythmias. In current clinical practice this has led to the increasing use of implantable defibrillators (ICDs).
Contraindication: ASV therapy is contraindicated in patients with chronic, symptomatic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnoea.
Patients with LVEF>45% continue to be eligible for ASV