Sleep Apnea Testing and Outcomes in a Large Cohort of Medicare Beneficiaries with Newly Diagnosed Heart Failure
- 15 February 2011
- journal article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 183 (4), 539-546
- https://doi.org/10.1164/rccm.201003-0406oc
Abstract
Previous studies have demonstrated a high prevalence of sleep apnea (SA) in patients with chronic heart failure (HF), which is associated with higher rates of morbidity, mortality, and health care use. To investigate the reported incidence, treatment, outcomes, and economic cost of SA in new-onset HF in a large U.S. database. This retrospective cohort study used the 2003 to 2005 Medicare Standard Analytical Files and included subjects with newly diagnosed HF from the first quarter of 2004, without prior diagnosis of SA, stratified by testing, diagnosis, and treatment status. Among a study population of 30,719 incident subjects with HF, only 1,263 (4%) were clinically suspected to have SA. Of these, 553 (2% of the total cohort) received SA testing, and 545 received treatment. After adjustment for age, sex, and comorbidities, subjects with HF who were tested, diagnosed, and treated for SA had a better 2-year survival rate compared with subjects with HF who were not tested (hazard ratio, 0.33 [95% confidence interval, 0.21-0.51], P < 0.0001). Similarly, among subjects who were tested and diagnosed, those who were treated had a better 2-year survival rate than those who were not treated (hazard ratio, 0.49 [95% confidence interval, 0.29-0.84], P = 0.009). In Medicare beneficiaries with HF, comorbid SA is most often not tested and consequently subjects are underdiagnosed and not treated. Meanwhile, in the few subjects in whom a diagnosis of SA is established and treatment is executed, survival improves significantly. These results support the importance of SA testing and treatment for patients newly diagnosed with HF.Keywords
This publication has 40 references indexed in Scilit:
- Sleep-Disordered Breathing and Mortality: A Prospective Cohort StudyPLoS Medicine, 2009
- Response to Cardiac Resynchronization Therapy Improves Renal Function: Importance of Forward and Backward FailureJournal of Cardiac Failure, 2009
- Current trends in heart failure readmission rates: analysis of medicare dataClinical Cardiology, 2009
- The Effect of Obstructive Sleep Apnea on Morbidity and Health Care Utilization of Middle‐Aged and Older AdultsJournal of the American Geriatrics Society, 2008
- Validation and Clinical Utility of a Simple In-Home Testing Tool for Sleep-Disordered Breathing and Arrhythmias in Heart Failure: Results of the Sleep Events, Arrhythmias, and Respiratory Analysis in Congestive Heart Failure (SEARCH) StudyCongestive Heart Failure, 2006
- Sleep disorders in systolic heart failure: A prospective study of 100 male patients. The final reportInternational Journal of Cardiology, 2006
- Effects of Nocturnal Oxygen Therapy on Outcome Measures in Patients With Chronic Heart Failure and Cheyne-Stokes RespirationCirculation Journal, 2006
- Continuous Positive Airway Pressure for Central Sleep Apnea and Heart FailureThe New England Journal of Medicine, 2005
- Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep ApneaThe New England Journal of Medicine, 2003
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987