Adaptive Servo-Ventilation Therapy Has Variable Effects in Heart Failure Patients

MedicalResearch.com Interview with:

Christopher M. O’Connor, MD FACC  CEO and Executive Director,  Inova Heart & Vascular Institute IHVI Administration Falls Church, Virginia 22042

Dr. Christopher O’Connor

Christopher M. O’Connor, MD FACC 
CEO and Executive Director,
Inova Heart & Vascular Institute
IHVI Administration
Falls Church, Virginia 22042

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sleep apnea is a very common comorbidity of patients with heart failure (both reduced ejection fraction and preserved ejection fraction). Early evidence from observational and small studies suggested that treating sleep apnea with adaptive servo-ventilation (ASV) therapy may improve patient outcomes. There is minimal clinical evidence about identifying and treating sleep apnea in those who’ve been hospitalized with acute decompensated heart failure. The CAT-HF study was designed to help address this, with the primary endpoint being cardiovascular outcomes measured as a Global Rank Score that included survival free from cardiovascular hospitalization and change in functional capacity as measured by the six-minute walk distance. It was also planned to expand on the SERVE-HF study that was investigating the use of ASV therapy to treat central sleep apnea (CSA) in chronic stable heart failure patients with reduced ejection fraction patients (HFrEF).

The CAT-HF study was stopped early based on the results of the SERVE-HF study, which showed an increased risk of cardiovascular mortality with use of ASV in patients with CSA and HFrEF. The primary endpoint of CAT-HF was neutral (Wilcoxon p-value = 0.717).

However, a pre-specified subgroup analysis showed a statistically significant improvement in the primary endpoint for people with moderate to severe sleep apnea and heart failure with preserved ejection fraction (HFpEF) (Cox p-value = 0.036).

MedicalResearch.com: What should readers take away from your report?

Response: Treating the comorbidity of sleep apnea with adaptive servo-ventilation therapy does not appear to benefit everyone with heart failure, but may improve outcomes for patients with HFpEF. However, this requires validation in a larger study.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: These findings encourage doing further research in a significantly larger cohort of patients with sleep apnea and HFpEF to further elucidate the potential benefits of treating sleep apnea with ASV therapy on this patient population. 

The CAT-HF study was funded by ResMed.

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Citation:

Cardiovascular Outcomes With Minute Ventilation–Targeted Adaptive Servo-Ventilation Therapy in Heart Failure The CAT-HF Trial Christopher M. O’Connor, MD,a,b David J. Whellan, MD,c Mona Fiuzat, PHARMD,a Naresh M. Punjabi, MD, PHD,d Gudaye Tasissa, PHD,a Kevin J. Anstrom, PHD,a Adam V. Benjafield, PHD,e Holger Woehrle, MD,f,g Amy B. Blase, BS,e JoAnn Lindenfeld, MD,h Olaf Oldenberg, MD
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
VOL. 69, NO. 12, 2017

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