Adaptive servo-ventilation (ASV) is a recently developed, noninvasive therapeutic tool for the treatment of heart failure (HF). However, prediction of responsiveness to continuous ASV therapy remains uncertain, especially in patients with advanced HF receiving guideline-directed medical therapy. A total of 47 patients with advanced HF (NYHA class IV 74%, inotrope infusion dependent 38%) received continuous ASV therapy at our institute between 2008 and 2014. Of these 47 patients, 12 (26%) were responders, whose left ventricular ejection fraction increased ≥ 5% during the 6-month study period. Shorter HF duration (< 17.2 × 10² days) was a significant predictor of responsiveness to ASV therapy by logistic regression analysis and receiver operating characteristics analysis. Patients with shorter HF duration achieved improved HF symptoms, recovery of renal function, and a lower readmission ratio compared with the longer HF duration group during ASV therapy. In conclusion, early ASV introduction may be beneficial to achieve left ventricular reverse remodeling during ASV therapy in patients with advanced HF.