ST vs ASV - studies about risk

[kiwii]

Hojo's thread is interesting too. http://www.apneaboard.com/forums/Thread-...mendations

At one point Spy Car says:

The main point was "the numbers," but that I felt wrecked. I was not getting refreshing sleep. I was suffering the consequences of cognitive impairment (constant brain fog) and had very significant fatigue.

I pushed hard to try ASV (against mild skepticism) as I need to do "something" as I was getting desperate.

ASV has been profoundly life-changing for me. I'm again experiencing quality sleep (something that was absent for a very long time). This has meant that I've been returning to being "human" again. I'm making a comeback.

That is how I feel. My brain doesn't feel terribly foggy at the moment, but I cannot track what people are saying or understand more than the simplest things.

I want to feel better too! At least I have a doctor that recognizes the need for a different machine and is interested in helping me. HalfAsleep doesn't even have that, and her events are way worse than mine! I'm so frustrated! 

[ajack]

A good psychiatrist will follow your lead and not reflect or amplify your thoughts, till you are able to confront or assimilate them. It shouldn't make the matter worse.

[kiwii]

A good psychiatrist will follow your lead and not reflect or amplify your thoughts, till you are able to confront or assimilate them. It shouldn't make the matter worse.

Right. However things do not always happen as they should. That is why I do not want to repeat a past mistake. I want someone that knows what they are doing, and knows what is and isn't okay for someone who has repressed childhood trauma. The only thing worse than getting something opened up (incorrectly/inappropriately), is being left to deal with it on your own because that session is over in one hour and then it's just you.

[Shin Ryoku]

Since this topic has been crossing over into other people's personal threads again, I thought it best to bump this one and let those other threads alone.


Ajack, you keep referring to a greater than 5-fold risk of sudden death without mentioning that those results were from a secondary analysis based on a very small number of patients and is only applicable to those patients who had an LVEF less than or equal to 30%. The 5-fold hazard ratio does not apply to everyone with low EF:

http://www.thelancet.com/journals/lanres...2/fulltext


To those who say SERVE-HF is invalid junk because it was an intention-to-treat analysis where many who were intended to use ASV did not do so, keep in mind that a separate on-treatment analysis of the data showed the same thing that the intention-to-treat analysis showed:

https://www.ncbi.nlm.nih.gov/pubmed/28860264


I think ResMed did a nice job of summarizing things with references*: resmed dot com /epn/en/healthcare-professional/diagnosis-and-treatment/about-csa/summary.html

*I don't know if I'm allowed to link to ResMed on this site, so please convert it to a URL.


Additional studies are needed and underway to clarify the safety and efficacy of ASV for CSA in patients with CHF and reduced EF. In the meanwhile, let's neither exaggerate the risks nor pretend that there are none.

[ajack]

You can have a preserved EF with HF and this subgroup did better than the other. we are specifically talking about those in the reduced EF subgroup.
Remembering that normal EF is 55-65% and the warning if for those with less than 45%
The HR is actually greater than 500% for those with low ejection, it is 5.21 for LVEF <30%


This video is worth watching on the review of the data and the complete series, by the people who actually did the SERVE-HF. This group really are world leaders is the field. They also tell of the current studies.
@ time stamp 9:35
https://www.youtube.com/watch?v=Nr08K5IfzzY&t=2484s

resmed use these videos for education on their youtube channel
https://www.youtube.com/watch?v=vdAz9MMs...9uL3Xrk9t_

[Shin Ryoku]

The HR is actually greater than 500% for those with low ejection, it is 5.21 for LVEF <30%

You often say the bolded part without mention of LV EF ≤30%, and without that context, it is misleading.

"low ejection" fraction is the same thing as reduced ejection fraction and would include people with with EF ≤30% as well as quite a few people with EF >30%.

Every time you talk about HR 5.21 or HR >500%, you should be specific that those numbers were found to be applicable in a subgroup of patients who had an LVEF less than or equal to 30%. Otherwise you are going to mislead people. Those numbers do not apply to everyone with low EF.

[ajack]

I think low ejection factor covers it. The actual group were those with under 35%. There are links and info where the data is from. If you opened the links before, we wouldn't be having this dialogue. I'm not writing a thesis.
The 5 fold number actually originated in a 5 minute section time stamped below, of the Q&A and low EF was the term used. It then goes on to describe "astronomical" numbers. So 500% isn't the high number.
https://youtu.be/Nr08K5IfzzY?t=2254

[Shin Ryoku]

I watched the video and read the study a long time ago.

The cutoff was less than or equal to 30%. It's plainly written that way even in their study abstract:

https://www.ncbi.nlm.nih.gov/m/pubmed/27592224/

"Low EF" has no specific meaning in medicine. It doesn't mean less than 30 or less than 35% EF. It may be used that way in the context of a discussion where someone has already mentioned a specific cutoff, but when you say it out of context, it means the same thing as "reduced EF" , which just means below normal.

[ajack]

You didn't look at the video link time stamp 9.35? it says it in black and white. Perhaps if you email your peer doctors and express your displeasure, on how they express themselves. For those of us that aren't doctors or even understand what a coxs HR is. Low EF works fine.
"The 5 fold number actually originated in a 5 minute section time stamped below, of the Q&A and low EF was the term used. It then goes on to describe "astronomical" numbers. So 500% isn't the high number."
https://youtu.be/Nr08K5IfzzY?t=2254

[Shin Ryoku]

You didn't look at the video link time stamp 9.35? it says it in black and white. Perhaps if you email your peer doctors and express your displeasure, on how they express themselves. For those of us that aren't doctors or even understand what a coxs HR is. Low EF works fine.
"The 5 fold number actually originated in a 5 minute section time stamped below, of the Q&A and low EF was the term used. It then goes on to describe "astronomical" numbers. So 500% isn't the high number."
https://youtu.be/Nr08K5IfzzY?t=2254

Less than a minute after he says "low ejection fraction", he says "patients with the lowest ejection fraction".  And when he goes on to say "astronomic", he is referring to the small subset of patients who both had the "lowest" ejection fractions AND also didn't have an implantable cardiac defibrillator. 

All of that is accurate and makes sense in the context of his discussion to people who have actually read the peer reviewed publication he is talking about.  

It loses accuracy when you take it out of context and simply say that people with low EF have an HR of 5.x or 500% without specifying before or after your comment how low an EF you are talking about.  If you're not going to provide any context or EF cutoff, it would be more accurate for you to say "lowest" rather than "low".  At least "lowest" implies an EF which is low even for someone with a subnormal EF.

Try Googling "low ejection fraction definition", and you will see that there is no specific EF cutoff for that term. Used out of context (as you have been using it), it simply means subnormal.

Again, keep in mind that the guy in the video is talking about the significance of his published study, and his intended audience is a group of people who read that study.  If someone did a video about a book they wrote, would you argue about the statements in the video if you hadn't read the book?