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Tamisier R, Damy T, Bailly S, Goutorbe F, Davy JM, Lavergne F, Palot A, Verbraecken JA, d'Ortho MP, Pépin JL, d'Ortho MP, Pépin JL, Davy JM, Damy T, Tamisier R. FACE study: 2-year follow-up of adaptive servo-ventilation for sleep-disordered breathing in a chronic heart failure cohort. Sleep Med 2024; 113:412-421. [PMID: 37612192 DOI: 10.1016/j.sleep.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a common comorbidity in patients with heart failure (HF) and is associated with worse prognosis. OBJECTIVES This study evaluated the effects of adaptive servo-ventilation (ASV) on morbidity and mortality in a large heterogeneous population of HF patients with different etiologies/phenotypes. METHODS Consecutive HF patients with predominant central sleep apnea (± obstructive sleep apnea) indicated for ASV were included; the control group included patients who refused or stopped ASV before three months follow-up. Six homogenous clusters were determined using the latent class analysis (LCA) method. The primary endpoint was time to composite first event (all-cause death, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening of chronic HF). RESULTS Of 503 patients at baseline, 324 underwent 2-year follow-up. Compared to control group, 2-year primary endpoint event-free survival was significantly greater in patients in ASV group only in univariable analysis (1.67, 95% [1.12-2.49]; p = 0.01). Secondary endpoints, event-free of cardiovascular death or heart failure-related hospitalization and all-cause death or all-cause hospitalization were positively impacted by ASV (univariate and multivariable analysis). LCA identified two groups, with preserved and mid-range left ventricular ejection fraction (LVEF) and severe hypoxia, in whom ASV increase prognosis benefit. CONCLUSIONS Patients with HF and SDB are a highly heterogeneous group identified using LCA. Systematic deep phenotyping is essential to ensure that ASV is prescribed to those benefit from therapy, as ASV use in patients with severe hypoxic burden and those with HFpEF was associated with a significant reduction in cardiovascular events and mortality. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01831128.
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Affiliation(s)
- Renaud Tamisier
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France.
| | - Thibaud Damy
- Service de Cardiologie, Centre de Référence Amyloses Cardiaques, GRC ARI, DHU ATVB, AP-HP, Hôpital Henri Mondor, Créteil, France; UFR médecine Université Paris-Est Créteil, France; Unité INSERM U981, Créteil, France
| | - Sébastien Bailly
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France
| | | | - Jean-Marc Davy
- Service de Cardiologie, CHU, Montpellier, France; UFR Médecine Université Montpellier, France
| | | | | | - Johan A Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Marie-Pia d'Ortho
- Université de Paris, Neuro Diderot, Inserm, Paris, France; Département de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat, Paris, France
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France
| | - Marie-Pia d'Ortho
- Université de Paris, Neuro Diderot, Inserm, Paris, France; Département de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat, Paris, France
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France
| | - Jean-Marc Davy
- Service de Cardiologie, CHU, Montpellier, France; UFR Médecine Université Montpellier, France
| | - Thibaud Damy
- Service de Cardiologie, Centre de Référence Amyloses Cardiaques, GRC ARI, DHU ATVB, AP-HP, Hôpital Henri Mondor, Créteil, France; UFR médecine Université Paris-Est Créteil, France; Unité INSERM U981, Créteil, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France
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Borghi C, Ciancio A, Gentile I, Perrone Filardi P, Pasqualetti P, Brillanti S. Evaluation of Drug Interactions in Patients Treated with DAAs for Hepatitis C Therapy with Comorbidities and Cardiovascular Issues-A Delphi Consensus Project. J Clin Med 2022; 11:jcm11236946. [PMID: 36498521 PMCID: PMC9737105 DOI: 10.3390/jcm11236946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022] Open
Abstract
Orally administered direct-acting antivirals (DAAs) have dramatically changed the possibility of curing HCV (hepatitis C virus) infection, with the two principal HCV regimens based on the combination of glecaprevir + pibrentasvir (GLE-PIB) and sofosbuvir + velpatasvir (SOF-VEL). A combination of drugs containing NS3/4A protease inhibitors, as well as the fact that almost all HCV patients can be treated at present, may expose patients to a higher rate of drug-drug interactions (DDIs). The hepatitis C treatment recommendations from the EASL (European Association for the Study of the Liver) state that, prior to starting treatment with a DAA, a detailed drug history should be taken; yet, the decision on managing the potential DDIs is not always clear. For this reason, a group of Italian cardiologists and hepatologists promoted a survey among colleagues to assess the controversial issues when treating patients with chronic hepatitis C taking concomitant cardiovascular drugs, aiming to reach a consensus on the best practice to apply when treating a patient with chronic hepatitis C who is taking concomitant drugs for cardiovascular diseases. Two consecutive questionnaires were proposed between June and July 2022 to a qualitative Expert Panel (EP) of 14 gastroenterologists, infectologists, hepatologists, and internists, with statistical analyses performed on 100% of the responses for both questionnaires. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. The interviewed experts consider DDIs a critical clinical problem to be evaluated in HCV patients. Therefore, dose changes, drug substitution, and discontinuation of concomitant cardiovascular drugs should be discouraged, even if planned for a relatively short period. Since oral DAAs have different DDIs profiles, hepatologists should prefer the antiviral DAA combination presenting the lowest instance of potential interactions.
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Affiliation(s)
- Claudio Borghi
- Internal Medicine, Department of Medical and Surgical Sciences, Policlinic S. Orsola-Malpighi, University of Bologna, 40126 Bologna, Italy
| | - Alessia Ciancio
- Gastroenterology Unit, Department of Internal Medicine, Città della Salute e delle Scienza di Torino (Molinette), University of Turin, 10126 Turin, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | | | - Patrizio Pasqualetti
- Section of Medical Statistics, Department of Public Health and Infectious Disease, Sapienza Rome University, 00185 Rome, Italy
- Correspondence:
| | - Stefano Brillanti
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
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