Long-term effects of PPV on heart failure outcomes

PPV clearly has a role in the treatment of acute HF exacerbations by helping reduce preload and afterload thereby improving cardiac output, but are there long-term benefits to PPV on HF specific outcomes? We know that HF can be worsened by sleep disordered breathing from both obstructive/restrictive and central etiologies so it is reasonable to hypothesize that PPV could improve mortality in these patients.

A recent meta-analysis looked at this question.

Subjects: Subjects with chronic HF who may or may not have had sleep disordered breathing.

Methods: 19 Controlled trials from lit review looking at standard HF medical therapy +/- sham PPV vs. standard HF medical therapy + PPV. 843 patients in total.

Outcomes: Mortality, LVEF, BNP

Results: PPV was associated with improvement in LVEF, BNP but NOT with mortality.

We’ve made huge strides in improving HF mortality in the last 30 years, but routine PPV does not seem to be part of our arsenal in improving HF related mortality.



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