Undiagnosed OSA associated with increased costs, readmission in patients with heart failure
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Previously undiagnosed obstructive sleep apnea in patients hospitalized with congestive heart failure was associated with increased costs and readmissions at 3 and 6 months compared with patients without sleep-disordered breathing, researchers reported.
“It is known that readmission rates are high for patients with congestive heart failure and readmission reduction efforts have only led to modest reductions. Moreover, these interventions can be costly to a health care system,” Nihal Patel, MD, fellow in the department of pulmonary, critical care and sleep medicine at The Ohio State University, Columbus, said during a presentation at the virtual CHEST Annual Meeting. “To improve the cost-effectiveness of intervention, heart failure readmission reduction programs should target high prevalence and high-cost populations. One such population may be those with OSA, which is known to have a high prevalence in heart failure patients and is independently associated with readmissions.”
Researchers assessed the OSU Sleep Heart Program, a prospective cohort study that includes 1,547 patients admitted for heart failure who underwent sleep studies during hospitalization from 2008 to 2012. OSA was defined as apnea-hypopnea index greater than 15 and a greater than 50% sleep apnea.
Patel and colleagues followed and tracked costs, readmissions and vital status after discharge and performed a post hoc analysis to compare the cost of hospitalizations between patients with OSA and those without sleep-disordered breathing.
Overall, 716 patients had OSA and 393 had no sleep-disordered breathing.
In patients with OSA, the 3-month readmission rate was 27.1% and 6-month readmission rate was 36.9% compared with 20.4% (P = .01) and 27.7% (P = .02), respectively, in patients without sleep-disordered breathing.
Estimated cumulative costs of readmission for patients with OSA at 3 months were $9,792 compared with $5,846 for patients without sleep-disordered breathing after adjustment for age, sex, BMI and left ventricular ejection fraction (P = .03). At 6 months, estimated cumulative costs of readmission for patients with OSA were $16,180 compared with $8,719 for patients without sleep-disordered breathing (P < .001).
“Inpatient sleep testing can help identify this high readmission risk population and targeted readmission reduction efforts can be utilized,” Patel said.