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  • Journal article
    Eulenburg C, Wegscheider K, Woehrle H, Angermann C, d'Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Zannad F, Teschler H, Cowie MRet al., 2016,

    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

    , The Lancet Respiratory Medicine, Vol: 4, ISSN: 2213-2600

    BACKGROUND: A large randomised treatment trial (SERVE-HF) showed that treatment of central sleep apnoea with adaptive servoventilation in patients with heart failure and reduced ejection fraction (HFREF) increased mortality, although the analysis of the composite primary endpoint (time to first event of death from any cause, life-saving cardiovascular intervention, or unplanned hospital admission for worsening heart failure) was neutral. This secondary multistate modelling analysis of SERVE-HF data investigated associations between adaptive servoventilation and individual components of the primary endpoint to try to better understand the mechanisms underlying the observed increased mortality. METHODS: In SERVE-HF, participants were randomly assigned to receive either optimum medical treatment for heart failure alone (control group), or in combination with adaptive servoventilation. We analysed individual components of the primary SERVE-HF endpoint separately in a multistate model, with and without three covariates suggested for effect modification (implantable cardioverter defibrillator at baseline, left ventricular ejection fraction [LVEF], and proportion of Cheyne-Stokes Respiration [CSR]). The SERVE-HF study is registered with, number NCT00733343. FINDINGS: Univariate analysis showed an increased risk of both cardiovascular death without previous hospital admission (hazard ratio [HR] 2·59, 95% CI 1·54-4·37, p<0·001) and cardiovascular death after a life-saving event (1·57, 1·01-2·44, p=0·045) in the group receiving adaptive servoventilation versus the control group. Adjusted analysis showed that the increased risk attributed to adaptive servoventilation of cardiovascular death without previous hospital admission for worsening heart failure varied with LVEF and that the risk attributed to adaptive servoventilation of hospital admission for worsening heart failure varied with LVEF and CSR

  • Journal article
    Chatwin M, Hawkins G, Panicchia L, Woods A, Hanak A, Lucas R, Baker E, Ramhamdany E, Mann B, Riley J, Cowie MR, Simonds AKet al., 2016,

    Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial).

    , Thorax, Vol: 71, Pages: 305-311, ISSN: 0040-6376

    OBJECTIVE: To assess the impact of home telemonitoring on health service use and quality of life in patients with severe chronic lung disease. DESIGN: Randomised crossover trial with 6 months of standard best practice clinical care (control group) and 6 months with the addition of telemonitoring. PARTICIPANTS: 68 patients with chronic lung disease (38 with COPD; 30 with chronic respiratory failure due to other causes), who had a hospital admission for an exacerbation within 6 months of randomisation and either used long-term oxygen therapy or had an arterial oxygen saturation (SpO2) of <90% on air during the previous admission. Individuals received telemonitoring (second-generation system) via broadband link to a hospital-based care team. OUTCOME MEASURES: Primary outcome measure was time to first hospital admission for an acute exacerbation. Secondary outcome measures were hospital admissions, general practitioner (GP) consultations and home visits by nurses, quality of life measured by EuroQol-5D and hospital anxiety and depression (HAD) scale, and self-efficacy score (Stanford). RESULTS: Median (IQR) number of days to first admission showed no difference between the two groups-77 (114) telemonitoring, 77.5 (61) control (p=0.189). Hospital admission rate at 6 months increased (0.63 telemonitoring vs 0.32 control p=0.026). Home visits increased during telemonitoring; GP consultations were unchanged. Self-efficacy fell, while HAD depression score improved marginally during telemonitoring. CONCLUSIONS: Telemonitoring added to standard care did not alter time to next acute hospital admission, increased hospital admissions and home visits overall, and did not improve quality of life in chronic respiratory patients. TRIAL REGISTRATION NUMBER: NCT02180919 (

  • Journal article
    Cowie MR, Wegscheider K, Teschler H, 2016,

    Adaptive Servo-Ventilation for Central Sleep Apnea in Heart Failure Reply

    , New England Journal of Medicine, Vol: 374, Pages: 690-691, ISSN: 1533-4406

    BACKGROUNDCentral sleep apnea is associated with poor prognosis and death in patients withheart failure. Adaptive servo-ventilation is a therapy that uses a noninvasive ventilatorto treat central sleep apnea by delivering servo-controlled inspiratory pressuresupport on top of expiratory positive airway pressure. We investigated the effectsof adaptive servo-ventilation in patients who had heart failure with reduced ejectionfraction and predominantly central sleep apnea.METHODSWe randomly assigned 1325 patients with a left ventricular ejection fraction of 45%or less, an apnea–hypopnea index (AHI) of 15 or more events (occurrences of apneaor hypopnea) per hour, and a predominance of central events to receiveguideline-based medical treatment with adaptive servo-ventilation or guidelinebasedmedical treatment alone (control). The primary end point in the time-toeventanalysis was the first event of death from any cause, lifesaving cardiovascularintervention (cardiac transplantation, implantation of a ventricular assistdevice, resuscitation after sudden cardiac arrest, or appropriate lifesaving shock),or unplanned hospitalization for worsening heart failure.RESULTSIn the adaptive servo-ventilation group, the mean AHI at 12 months was 6.6 eventsper hour. The incidence of the primary end point did not differ significantly betweenthe adaptive servo-ventilation group and the control group (54.1% and50.8%, respectively; hazard ratio, 1.13; 95% confidence interval [CI], 0.97 to 1.31;P=0.10). All-cause mortality and cardiovascular mortality were significantlyhigher in the adaptive servo-ventilation group than in the control group (hazardratio for death from any cause, 1.28; 95% CI, 1.06 to 1.55; P=0.01; and hazardratio for cardiovascular death, 1.34; 95% CI, 1.09 to 1.65; P=0.006).CONCLUSIONSAdaptive servo-ventilation had no significant effect on the primary end point inpatients who had heart failure with reduced ejection fraction and predominantlycentral sleep apnea, but al

  • Journal article
    Linz D, Fox H, Bitter T, Spiesshoefer J, Schoebel C, Skobel E, Tueroff A, Boehm M, Cowie MR, Arzt M, Oldenburg Oet al., 2016,

    Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies

    , Clinical Research in Cardiology, Vol: 105, Pages: 563-570, ISSN: 1861-0692
  • Journal article
    Cowie MR, 2016,

    What is the role of telemonitoring in heart failure?

    , Dialogues in Cardiovascular Medicine, Vol: 21, Pages: 35-44, ISSN: 1272-9949

    © 2016, AICH - Servier Research Group. Heart failure disease management programs are well established and their role in supporting self-care and improving outcomes is recognized in international guidelines. However, access to such programs is limited. Telemonitoring, the monitoring of patients using information technology to collect health-related information and transmit this data to a health care professional, who is remote from that patient, offers the opportunity for the patient and health care professional to adopt a proactive approach to the early detection of clinical deterioration, optimization of medication, and education for self-care. However, the evidence that it improves outcomes over and above the best usual practice is thin, meaning that any benefit will come at an additional expense and organizational disruption. Convenience and acceptability are high for the patients, but adoption remains slow due to a frequent lack of reimbursement.

  • Journal article
    Lucas R, Riley JP, Mehta PA, Goodman H, Banya W, Mulligan K, Newman S, Cowie MRet al., 2015,

    The effect of heart failure nurse consultations on heart failure patients' illness beliefs, mood and quality of life over a six-month period

    , JOURNAL OF CLINICAL NURSING, Vol: 24, Pages: 256-265, ISSN: 0962-1067
  • Journal article
    Morgan JM, Dimitrov BD, Gill J, Kitt S, Ng GA, McComb JM, Raftery J, Roderick P, Seed A, Williams SG, Witte KK, Wright DJ, Yao GL, Cowie MRet al., 2014,

    Rationale and study design of the REM-HF study: remote management of heart failure using implanted devices and formalized follow-up procedures

    , EUROPEAN JOURNAL OF HEART FAILURE, Vol: 16, Pages: 1039-1045, ISSN: 1388-9842
  • Journal article
    Cowie MR, Woehrle H, Wegscheider K, Angermann C, d'Ortho M-P, Erdmann E, Levy P, Simonds A, Somers VK, Zannad F, Teschler Het al., 2014,

    Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure

    , European Journal of Heart Failure, Vol: 15, Pages: 937-943, ISSN: 1879-0844

    AimsCentral sleep apnoea/Cheyne–Stokes respiration (CSA/CSR) is a risk factor for increased mortality and morbidity in heart failure (HF). Adaptive servo-ventilation (ASV) is a non-invasive ventilation modality for the treatment of CSA/CSR in patients with HF.MethodsSERVE-HF is a multinational, multicentre, randomized, parallel trial designed to assess the effects of addition of ASV (PaceWave™, AutoSet CS™; ResMed) to optimal medical management compared with medical management alone (control group) in patients with symptomatic chronic HF, LVEF ≤45%, and predominant CSA. The trial is based on an event-driven group sequential design, and the final analysis will be performed when 651 events have been observed or the study is terminated at one of the two interim analyses. The aim is to randomize ∼1200 patients to be followed for a minimum of 2 years. Patients are to stay in the trial up to study termination. The first patient was randomized in February 2008 and the study is expected to end mid 2015. The primary combined endpoint is the time to first event of all-cause death, unplanned hospitalization (or unplanned prolongation of a planned hospitalization) for worsening (chronic) HF, cardiac transplantation, resuscitation of sudden cardiac arrest, or appropriate life-saving shock for ventricular fibrillation or fast ventricular tachycardia in implantable cardioverter defibrillator patients.PerspectivesThe SERVE-HF study is a randomized study that will provide important data on the effect of treatment with ASV on morbidity and mortality, as well as the cost-effectiveness of this therapy, in patients with chronic HF and predominantly CSA/CSR.Trial registrationISRCTN19572887

  • Journal article
    Goodman H, Firouzi A, Banya W, Lau-Walker M, Cowie MRet al., 2013,

    Illness perception, self-care behaviour and quality of life of heart failure patients: A longitudinal questionnaire survey

    , INTERNATIONAL JOURNAL OF NURSING STUDIES, Vol: 50, Pages: 945-953, ISSN: 0020-7489
  • Journal article
    Riley JP, Gabe JPN, Cowie MR, 2013,

    Does telemonitoring in heart failure empower patients for self-care? A qualitative study.

    , Journal of Clinical Nursing
  • Journal article
    Mulligan K, Mehta PA, Fteropoulli T, Dubrey SW, McIntyre HF, McDonagh TA, Sutton GC, Walker DM, Cowie MR, Newman Set al., 2012,

    Newly diagnosed heart failure: Change in quality of life, mood, and illness beliefs in the first 6 months after diagnosis

    , BRITISH JOURNAL OF HEALTH PSYCHOLOGY, Vol: 17, Pages: 447-462, ISSN: 1359-107X
  • Journal article
    Cowie MR, Lobos AA, 2012,

    Telemonitoring for patients with heart failure

    , CANADIAN MEDICAL ASSOCIATION JOURNAL, Vol: 184, Pages: 509-510, ISSN: 0820-3946
  • Journal article
    Dar O, Riley J, Chapman C, Dubrey SW, Morris S, Rosen SD, Roughton M, Cowie MRet al., 2009,

    A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home-HF study

    , EUROPEAN JOURNAL OF HEART FAILURE, Vol: 11, Pages: 319-325, ISSN: 1388-9842

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