Pulmonary Hypertension is Associated with Increased Mortality and Readmission in Patients with Obstructive Sleep Apnea Admitted for Heart Failure Exacerbation

Abstract

Background Pulmonary hypertension (PH) is common among patients with heart failure (HF) and obstructive sleep apnea (OSA) but little data exists regarding how it influences readmission and mortality Objectives We assessed the hypothesis that the presence and severity of PH in patients with OSA admitted with acute decompensated heart failure (ADHF) are associated with hospital readmission and mortality Methods We retrospectively examined consecutive patients admitted to the hospital for ADHF between September 2014 and September 2015 and identified patients with OSA. For patients admitted multiple times, only the index admission was included. The primary endpoints were readmission for heart failure and all-cause readmission. All-cause mortality was a secondary endpoint. The severity of PH was assessed using transthoracic echocardiography. Estimated pulmonary artery systolic pressures (PASP) were individually verified by a single reviewer. Right atrial pressures were estimated using American Society of Echocardiography guidelines on inferior vena cava diameter. Multivariable Cox proportional-hazards regression was used to assess the relationship between PASP and outcomes Results Of 263 patients admitted for ADHF, 62 (24%) had OSA. Patients were 70±7 years old, predominantly white (77%) and male (100%). Thirty-eight (61%) of the OSA patients had PH classified as PASP>36 mmHg; 11 (18%) had severe PH as classified as PASP >60 mmHg. Of the 38 patients with OSA and PH, 17 (44%) had heart failure with preserved ejection fraction, and 21 (55%) had some degree of right ventricular dysfunction as noted on the echocardiogram report. ADHF+OSA patients with PH were more likely to be readmitted within 90 days than those without PH (55% vs 37%). Over a mean follow-up duration of 15 months, ADHF+OSA patients with PH also had significantly increased risk of mortality (HR=2.74, 95% CI 1.01-7.49, p=0.048) Conclusions Patients with HF and OSA have a high prevalence of PH and right ventricular dysfunction. The presence of PH as estimated by echocardiography is associated with readmission and mortality in these patients. Figure 1