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• W2565057557 abstract "We thank Emir Festic for his comment on our Article.1Eulenburg C Wegscheider K Woehrle H et al.Mechanisms underlying increased mortality risk in patients with heart failure and reduced ejection fraction randomly assigned to adaptive servoventilation in the SERVE-HF study: results of a secondary multistate modelling analysis.Lancet Respir Med. 2016; 4: 873-881Summary Full Text Full Text PDF PubMed Scopus (71) Google Scholar Overall, 217 (16·4%) of 1325 patients used anti-arrhythmic drugs (chiefly amiodarone) at baseline in the SERVE-HF cohort (89 [13·5%] of 659 patients randomised to the control group and 128 [19·2%] of 666 patients randomised to the adaptive servoventilation [ASV] group [p<0·05]). Adjustment for this baseline covariate (as a potential confounding variable or as a marker for the perception of a higher propensity to arrhythmia) did not change the estimates of the increased all-cause mortality or cardiovascular mortality in the intention to treat analyses of these secondary endpoints, as reported in the primary manuscript and appendix figures 1A, 1B, and 1C.2Cowie MR Woehrle H Wegscheider K et al.Adaptive servo-ventilation for central sleep apnea in systolic heart failure.N Engl J Med. 2015; 373: 1095-1105Crossref PubMed Scopus (694) Google Scholar In the multistate analysis,1Eulenburg C Wegscheider K Woehrle H et al.Mechanisms underlying increased mortality risk in patients with heart failure and reduced ejection fraction randomly assigned to adaptive servoventilation in the SERVE-HF study: results of a secondary multistate modelling analysis.Lancet Respir Med. 2016; 4: 873-881Summary Full Text Full Text PDF PubMed Scopus (71) Google Scholar we did not present analyses adjusted for antiarrhythmic medication. When this adjustment is made, the unadjusted hazard ratio (HR) of 2·59 (95% CI 1·54–4·37) for ASV versus control changes to 2·52 (1·49–4·26) for the endpoint of cardiovascular death without previous hospital admission for worsening heart failure or lifesaving intervention. Separating analyses of this endpoint with respect to anti-arrhythmic use at baseline reveals that the point estimate for the HR of ASV therapy versus control is higher for those who were taking an anti-arrhythmic (5·53, 95% CI 1·23–24·88), than for the majority who were not taking such a drug (2·19, 95% CI 1·24–3·86) but with overlapping 95% CIs and non-significant interaction (p=0·432). Thus, a confounding or interacting effect of anti-arrhythmic drugs at baseline (or an increased propensity for arrhythmia) is unlikely to be the explanation for the increased risk of cardiovascular death reported in SERVE-HF. The authors' declarations of interests remain the same as those declared in the original Article. Mechanisms underlying increased mortality risk in patients with heart failure and reduced ejection fraction randomly assigned to adaptive servoventilation in the SERVE-HF study: results of a secondary multistate modelling analysisAdaptive servoventilation is associated with an increased risk of cardiovascular death in patients with heart failure and reduced ejection fraction (LVEF ≤45%) treated for predominant central sleep apnoea. This multistate modelling analysis shows that this risk is increased for cardiovascular death in patients not previously admitted to hospital, presumably due to sudden death, and in patients with poor left ventricular function. Full-Text PDF Baseline use of antiarrhythmics in patients given adaptive servoventilation: SERVE-HFI read with interest the results of a secondary multistate modelling analysis from the SERVE-HF study1 reported by Eulenberg and colleagues2 in The Lancet Respiratory Medicine. Perhaps the most interesting finding was that patients who were randomly assigned to receive adaptive servoventilation had a significantly increased risk of cardiovascular death, without a hospital admission before death. Additionally, in the subgroup without an implantable cardioverter or defibrillator at baseline and left ventricular ejection fraction (LVEF) of less than or equal to 30%, the authors estimated the hazard ratio for cardiovascular death without previous hospital admission in patients allocated to adaptive servoventilation to be 24·08 (95% CI 3·14–184·46, p=0·003). Full-Text PDF" @default.
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• W2565057557 date "2017-01-01" @default.
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• W2565057557 title "Baseline use of antiarrhythmics in patients given adaptive servoventilation: SERVE-HF—Authors' reply" @default.
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• W2565057557 doi "https://doi.org/10.1016/s2213-2600(16)30428-3" @default.
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