The year in cardiology 2015: heart failure

Abstract

A number of studies conducted both in heart failure with reduced and with preserved ejection fraction were presented and published in 2015. Most of them were neutral and did not demonstrate any benefit on outcomes of the drugs/procedures tested. Nevertheless, they bring important new information on the search for new drugs or procedures in the management of heart failure. Sleep-disordered breathing is common in patients with heart failure and reduced ejection fraction. Two different types of abnormality have been described: obstructive sleep apnoea and central sleep apnoea. The prevalence of central sleep apnoea, which may manifest as Cheynes–Stokes respiration, increases with the severity of heart failure and this condition is associated with poor outcomes. The purpose of SERVE-HF was to assess the effects of adaptive servo-ventilation (ASV) that delivers servo-controlled inspiratory pressure support on top of expiratory positive airway pressure in patients with moderate to severe heart failure and an ejection of <45% who had predominantly central sleep apnoea.1 In this trial, 1325 patients were enrolled and randomized to ASV (666) or to control therapy (659). Patients were predominantly in New York Heart Association Class III and were well treated by recommended therapies. The incidence of the primary endpoint made of the composite of death of any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for heart failure did not differ significantly between the two groups (HR = 1.13; 95% CI, 0.97–1.31; P = 0.10). The surprise was the observation of a significant increase of all-cause mortality (HR = 1.28; 95% CI, 1.06–1.55; P = 0.01) and of cardiovascular mortality (HR = 1.34; 95% CI, 1.09–1.65; P = 0.006) in the ASV group. The findings …