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Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial.

Publication ,  Journal Article
O'Connor, CM; Whellan, DJ; Fiuzat, M; Punjabi, NM; Tasissa, G; Anstrom, KJ; Benjafield, AV; Woehrle, H; Blase, AB; Lindenfeld, J; Oldenburg, O
Published in: J Am Coll Cardiol
March 28, 2017

BACKGROUND: Sleep apnea is common in hospitalized heart failure (HF) patients and is associated with increased morbidity and mortality. OBJECTIVES: The CAT-HF (Cardiovascular Improvements With MV-ASV Therapy in Heart Failure) trial investigated whether minute ventilation (MV) adaptive servo-ventilation (ASV) improved cardiovascular outcomes in hospitalized HF patients with moderate-to-severe sleep apnea. METHODS: Eligible patients hospitalized with HF and moderate-to-severe sleep apnea were randomized to ASV plus optimized medical therapy (OMT) or OMT alone (control). The primary endpoint was a composite global rank score (hierarchy of death, cardiovascular hospitalizations, and percent changes in 6-min walk distance) at 6 months. RESULTS: 126 of 215 planned patients were randomized; enrollment was stopped early following release of the SERVE-HF (Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure) trial results. Average device usage was 2.7 h/night. Mean number of events measured by the apnea-hypopnea index decreased from 35.7/h to 2.1/h at 6 months in the ASV group versus 35.1/h to 19.0/h in the control group (p < 0.0001). The primary endpoint did not differ significantly between the ASV and control groups (p = 0.92 Wilcoxon). Changes in composite endpoint components were not significantly different between ASV and control. There was no significant interaction between treatment and ejection fraction (p = 0.10 Cox model); however, pre-specified subgroup analysis suggested a positive effect of ASV in patients with HF with preserved ejection fraction (p = 0.036). CONCLUSIONS: In hospitalized HF patients with moderate-to-severe sleep apnea, adding ASV to OMT did not improve 6-month cardiovascular outcomes. Study power was limited for detection of safety signals and identifying differential effects of ASV in patients with HF with preserved ejection fraction, but additional studies are warranted in this population. (Cardiovascular Improvements With MV ASV Therapy in Heart Failure [CAT-HF]; NCT01953874).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

March 28, 2017

Volume

69

Issue

12

Start / End Page

1577 / 1587

Location

United States

Related Subject Headings

  • United States
  • Sleep Apnea Syndromes
  • Positive-Pressure Respiration
  • Middle Aged
  • Male
  • Inpatients
  • Humans
  • Heart Failure
  • Female
  • Cardiovascular System & Hematology
 

Citation

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O’Connor, C. M., Whellan, D. J., Fiuzat, M., Punjabi, N. M., Tasissa, G., Anstrom, K. J., … Oldenburg, O. (2017). Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial. J Am Coll Cardiol, 69(12), 1577–1587. https://doi.org/10.1016/j.jacc.2017.01.041
O’Connor, Christopher M., David J. Whellan, Mona Fiuzat, Naresh M. Punjabi, Gudaye Tasissa, Kevin J. Anstrom, Adam V. Benjafield, et al. “Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial.J Am Coll Cardiol 69, no. 12 (March 28, 2017): 1577–87. https://doi.org/10.1016/j.jacc.2017.01.041.
O’Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ, et al. Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial. J Am Coll Cardiol. 2017 Mar 28;69(12):1577–87.
O’Connor, Christopher M., et al. “Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial.J Am Coll Cardiol, vol. 69, no. 12, Mar. 2017, pp. 1577–87. Pubmed, doi:10.1016/j.jacc.2017.01.041.
O’Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ, Benjafield AV, Woehrle H, Blase AB, Lindenfeld J, Oldenburg O. Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial. J Am Coll Cardiol. 2017 Mar 28;69(12):1577–1587.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

March 28, 2017

Volume

69

Issue

12

Start / End Page

1577 / 1587

Location

United States

Related Subject Headings

  • United States
  • Sleep Apnea Syndromes
  • Positive-Pressure Respiration
  • Middle Aged
  • Male
  • Inpatients
  • Humans
  • Heart Failure
  • Female
  • Cardiovascular System & Hematology