Positive Airway Pressure Adherence and Health Care Resource Utilization in Patients With Obstructive Sleep Apnea and Heart Failure With Reduced Ejection Fraction

• DOI: 10.1161/jaha.122.028732
• Publication Date: 2023-05-15T10:15:05Z
• Authors: Atul Malhotra; Kate V. Cole; Anita S. Malik; Jean‐Louis Pépin; Fatima H. Sert Ku...; Peter A. Cistulli; Adam V. Benjafield; Virend K. Somers; Peter Cistulli; Atul Malhotra; Jean‐Louis Pépin; Adam V. Benjafield; Kimberly L. Sterling; Carlos M. Nunez; Meredith Barrett; Jeff Armitstead
• Keywords: Male; Sleep Apnea; [SDV]Life Sciences [q-bio]; 610; heart failure; positive airway pressure adherence; Cardiorespiratory Medicine and Haematology; Cardiovascular; Medicare; Cardiovascular medicine and haematology; Clinical Research; Cardiovascular Medicine and Haematology; Diseases of the circulatory (Cardiovascular) system; Humans; Lung; medXcloud group *; obstructive sleep apnea; Original Research; Aged; Heart Failure; Sleep Apnea, Obstructive; Biomedical and Clinical Sciences; health care resource utilization; Continuous Positive Airway Pressure; Obstructive; 600; Stroke Volume; Health Services; Middle Aged; Patient Acceptance of Health Care; United States; 3. Good health; Heart Disease; Good Health and Well Being; RC666-701; Patient Compliance; Female; Sleep Research

Background Obstructive sleep apnea (OSA) is a common comorbidity in patients with heart failure, although current evidence is equivocal regarding the potential benefits of treating OSA with positive airway pressure (PAP) therapy in patients with heart failure. This study assessed the impact of adherence to PAP therapy on health care resource utilization in patients with OSA and heart failure with reduced ejection fraction.

Methods and Results

Administrative insurance claims data linked with objective PAP therapy use data from patients with OSA and heart failure with reduced ejection fraction were used to determine associations between PAP adherence and a composite outcome of hospitalizations and emergency room visits. One‐year PAP adherence was based on an adapted US Medicare definition. Propensity score methods were used to create groups with similar characteristics across PAP adherence levels. The study cohort included 3182 patients (69.9% male, mean age 59.7 years); 39% were considered adherent to PAP therapy (29% intermediate adherent, 31% nonadherent). One year after PAP initiation, adherent patients had fewer composite visits than matched nonadherent patients, driven by a 24% reduction in emergency room visits for adherent patients. Composite visit costs were lower in adherent versus nonadherent patients ($3500 versus $5879, P =0.031), although total health care costs were not statistically different ($13 028 versus $14 729, P =0.889).

Conclusions PAP therapy adherence in patients with OSA with heart failure with reduced ejection fraction was associated with a reduction in health care resource utilization. This suggests that greater emphasis should be placed on diagnosing and effectively treating OSA with PAP in patients with heart failure with reduced ejection fraction.