Positive Airway Pressure Therapy Adherence and Health Care Resource Use in Patients With Obstructive Sleep Apnea and Heart Failure With Preserved Ejection Fraction

Background Obstructive sleep apnea (OSA) is common in heart failure with preserved ejection fraction (HFpEF). However, current evidence is equivocal regarding the potential benefits of treating OSA with positive airway pressure (PAP) therapy in HFpEF. This study assessed the association between adhe...

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Bibliographic Details
Published in:Journal of the American Heart Association 2023-07, Vol.12 (14), p.e028733-e028733
Main Authors: Cistulli, Peter A, Malhotra, Atul, Cole, Kate V, Malik, Anita S, Pépin, Jean-Louis, Sert Kuniyoshi, Fatima H, Benjafield, Adam V, Somers, Virend K
Format: Article
Language:English
Subjects:
Aged
Continuous Positive Airway Pressure
Female
Health Care Costs
health care resource use
heart failure
Heart Failure - therapy
Humans
Life Sciences
Male
Medicare
Middle Aged
obstructive sleep apnea
Original Research
Patient Compliance
positive airway pressure adherence
Retrospective Studies
Sleep Apnea, Obstructive
Stroke Volume
United States - epidemiology
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Summary:Background Obstructive sleep apnea (OSA) is common in heart failure with preserved ejection fraction (HFpEF). However, current evidence is equivocal regarding the potential benefits of treating OSA with positive airway pressure (PAP) therapy in HFpEF. This study assessed the association between adherence to PAP therapy and health care resource use in patients with OSA and HFpEF. Methods and Results Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFpEF were used to determine associations between PAP adherence and a composite outcome including 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 4237 patients (54.0% female, mean age 64.1 years); 40% were considered adherent to PAP therapy (30% intermediate adherent, 30% nonadherent). In the matched cohort, PAP-adherent patients had fewer health care resource use visits than nonadherent patients, a 57% decrease in hospitalizations, and a 36% decrease in emergency room visits versus the year before PAP initiation. Total health care costs were lower in adherent patients than nonadherent patients ($12 732 versus $15 610,
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.122.028733