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Effect of Early Intervention With Positive Airway Pressure Therapy for Sleep Disordered Breathing on Six-Month Readmission Rates in Hospitalized Patients With Heart Failure

  • Sunil Sharma
    Correspondence
    Corresponding author: Tel: (+1) 215-955-8285; fax: (+1) 215-955-9783.
    Affiliations
    Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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  • Paul Mather
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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  • Ankit Gupta
    Affiliations
    Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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  • Gordon Reeves
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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  • Sharon Rubin
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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  • Raphael Bonita
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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  • Anindita Chowdhury
    Affiliations
    Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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  • Raymond Malloy
    Affiliations
    Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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  • Leslee Willes
    Affiliations
    Independent Biostatician, Willes Consulting Group, Inc., Encinitas, California
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  • David Whellan
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Published:December 31, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.12.032
      Rehospitalization for congestive heart failure (CHF) is high within 6 months of discharge. Sleep disordered breathing (SDB) is common and underdiagnosed condition in patients with CHF. We hypothesized that early recognition and treatment of SDB in hospitalized patients with CHF will reduce hospital readmissions and emergency room visits. Patients admitted for CHF underwent overnight polysomnography within 4 weeks of discharge. Patients diagnosed with SDB were provided therapy with positive airway pressure therapy. Patients were identified as having good compliance if the device use was for a minimum of 4 hours 70% of the time for a minimum of 4 weeks during the first 3 months of therapy. Hospital admissions for 6 months before therapy were compared with readmission within 6 months after therapy in patients with good and poor compliance. A total of 70 patients were diagnosed with SDB after discharge. Of the 70 patients, 37 (53%) were compliant with positive airway pressure therapy. Compliant patients were more likely to be older (64 ± 12 vs 58 ± 11 years) and women (54% vs 33%) and less likely to be patient with diabetes (40% vs 67%) versus noncompliant patients. Although both groups experienced a decrease in total readmissions, compliant patients had a significant reduction (mean ± SE: −1.5 ± 0.2 clinical events vs −0.2 ± 0.3; p <0.0001). In this single-center analysis, identification and treatment of SDB in admitted patients with CHF with SDB is associated with reduced readmissions over 6 months after discharge. Adherence to the treatment was associated with a greater reduction in clinical events.
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