ASV Contraindicated SERVE-HF — EECC MCQ

Correct answer: B — Optimise HF GDMT first — CSR reflects the severity of HF (driven by circulatory delay and heightened chemosensitivity); adaptive servo-ventilation (ASV) is CONTRAINDICATED in HFrEF with CSA based on the SERVE-HF trial which showed increased mortality

Cheyne-Stokes respiration (CSR) with central sleep apnoea (CSA) occurs in 30-40% of HFrEF patients. Mechanism: reduced cardiac output → prolonged circulatory time → delayed detection of CO₂ changes by central chemoreceptors → oscillating hyperventilation and apnoea. CSR is a MARKER of HF severity (not a primary sleep disorder). The SERVE-HF trial (2015) was terminated early: ASV increased all-cause and CV mortality by ~30% compared with control in HFrEF patients with predominant CSA. The mechanism of harm is unclear (possibly: ASV suppresses the compensatory hyperventilation phase, worsening hypoxia; or eliminates arousal responses). The ESC 2023 HF Guidelines recommend: (1) optimise GDMT (CSR often improves with HF treatment); (2) ASV is CONTRAINDICATED (Class III); (3) CPAP has limited evidence for CSA (unlike OSA where CPAP is beneficial); (4) supplemental oxygen and phrenic nerve stimulation are investigational.

Reference: ESC (2023): HF Guidelines; SERVE-HF Trial