Health care resource utilization among patients with heart failure (HF) with reduced ejection fraction (HFrEF) and obstructive sleep apnea (OSA) is related to adherence to positive airway pressure (PAP) therapy. These findings were published in the Journal of the American Heart Association.
Sleep-disordered breathing is common among patients with HFrEF and investigators from the medXcloud group hypothesized that among these patients, adherence to PAP therapy would be associated with reduced health care utilization.
To test their hypothesis, they conducted this retrospective, observational study using data from deidentified administrative claims collected by more than 100 health care plans in the United States. Patients (N=3182) with HFrEF who received a new diagnosis of OSA between 2014 and 2019 were evaluated for healthcare utilization on the basis of adherence to PAP therapy. Treatment adherence was objectively measured by PAP devices during the first year of use and patient compliance was defined as use for 4 or more hours per night on 70% of nights over 30 consecutive days in a 90-day period. Adherence was defined as compliance in all 4 quarters in the first year, intermediate adherence as compliance in 1 to 3 quarters in the first year, and nonadherence as noncompliance in all quarters in the first year. To balance for cohort differences, adherent and nonadherent patients were matched in a 1:1 ratio.
The patients had a mean age of 59.7 (SD, 11.2) years, 30.1% were women, 39.0% were morbidly obese, 27.3% had an implanted cardiac device, 80.1% were using beta-blockers, 64.9% were using diuretics, and 5.6 (SD, 2.3) had comorbid conditions.
In the first quarter of device use, 63.2% were compliant to treatment and during the first year of treatment, 39% were adherent. Predictors for PAP adherence included older age, atrial fibrillation, and adherence to beta-blockers.
Among a subset of 738 adherent and 738 nonadherent patients, the treatment adherent group had higher rates of PAP use with regards to hours per day (mean, 6.6 vs 0.4; P <.001), days per week (mean, 6.6 vs 0.9; P <.001), and hours per use per day (mean, 7.0 vs 2.9; P <.001) compared with the nonadherent group.
The composite outcome of health care resource utilization in the first year of PAP use was significantly lower among the PAP adherent group compared with the nonadherent group (mean, 0.92 vs 1.15 visits; P =.006). Stratified by type of visit, PAP adherence associated with fewer emergency department (ED) visits (mean, 0.64 vs 0.81; P =.005) but not fewer all-cause (mean, 0.28 vs 0.34; P =.140) or cardiovascular (mean, 0.09 vs 0.11; P =.409) hospitalizations compared with nonadherence.
Among all patients, PAP adherence associated with fewer ED visits than nonadherence (P <.001) and with fewer ED visits (P =.002) and all-cause hospitalizations (P =.049) compared with intermediate adherence.
“These data provide additional real-world evidence for the role of PAP therapy in reducing health care resource use. Therefore, assessment of OSA in patients with heart failure should be encouraged until more definitive outcomes data emerge,” wrote the study authors.
Disclosures: This research was supported by ResMed. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Malhotra A, Cole KV, Malik AS, et al.; on behalf of the medXcloud group. Positive airway pressure adherence and health care resource utilization in patients with obstructive sleep apnea and heart failure with reduced ejection fraction. J Am Heart Assoc. Published online May 15, 2023. doi:10.1161/JAHA.122.028732