Diagnosis and Treatment of Sleep Disordered Breathing in Hospitalized Cardiac Patients: A Reduction in 30-Day Hospital Readmission Rates.
Kauta SR, Keenan BT, Goldberg L, Schwab RJ.
Author information
Abstract
Background:
Sleep disordered breathing (SDB) is associated with significant cardiovascular sequelae and positive airway pressure (PAP) has been shown to improve heart failure and prevent the recurrence of atrial fibrillation in cardiac patients with sleep apnea. Patients who are hospitalized with cardiac conditions frequently have witnessed symptoms of SDB but often do not have a diagnosis of sleep apnea. We implemented a clinical paradigm to perform unattended sleep studies and initiate treatment with PAP in hospitalized cardiac patients with symptoms consistent with SDB. We hypothesized that PAP adherence in cardiac patients with SDB would reduce readmission rates 30 days after discharge.
Methods:
106 consecutive cardiac patients hospitalized for heart failure, arrhythmias, and myocardial infarction and who reported symptoms of SDB were evaluated. Patients underwent a type III portable sleep study and those patients diagnosed with sleep apnea were started on PAP. Demographic data, SDB type, PAP adherence, and data regarding 30-day hospital readmission/ED visits were collected.
Results:
Of 106 patients, 104 had conclusive diagnostic studies using portable monitoring systems. Seventy-eight percent of patients (81/104) had SDB (AHI ≥ 5 events/h). Eighty percent (65/81) had predominantly obstructive sleep apnea, and 20% (16/81) had predominantly central sleep apnea. None of 19 patients (0%) with adequate PAP adherence, 6 of 20 (30%) with partial PAP use, and 5 of 17 (29%) of patients who did not use PAP were readmitted to the hospital or visited the emergency department (ED) for a cardiac issue within 30 days from discharge (p = 0.025).
Conclusions:
Performing diagnostic unattended sleep studies and initiating PAP treatment in hospitalized cardiac patients was feasible and provided important clinical information. Our data indicate that hospital readmission and ED visits 30 days after discharge were significantly lower in patients with cardiac disease and SDB who adhered to PAP treatment than those who were not adherent.
2014 American Academy of Sleep Medicine.
http://www.ncbi.nlm.nih.gov/pubmed/25238310
Cardiac Patients: A Reduction in 30-Day Hospital Readmission
Cardiac Patients: A Reduction in 30-Day Hospital Readmission
I am not a medical professional and I have no medical training.
Re: Cardiac Patients: A Reduction in 30-Day Hospital Readmission
Fantastic find.
One problem hospitals are having is that a CPT code is not chargable for in patient sleep studies...either clinical or type-3 monitoring device...is not available. (If I am wrong please tell me this). I would jump at the information of having an in-house sleep study for cardiac pts.
However, I am also finding that even with the ppl using a HST unit to diagnose OSA, many are coming to the sleep lab for a titration study. This seems to be happen for the ppl with moderate to high OSA.
One problem hospitals are having is that a CPT code is not chargable for in patient sleep studies...either clinical or type-3 monitoring device...is not available. (If I am wrong please tell me this). I would jump at the information of having an in-house sleep study for cardiac pts.
However, I am also finding that even with the ppl using a HST unit to diagnose OSA, many are coming to the sleep lab for a titration study. This seems to be happen for the ppl with moderate to high OSA.
- Sir NoddinOff
- Posts: 4190
- Joined: Mon May 14, 2012 5:30 pm
- Location: California
Re: Cardiac Patients: A Reduction in 30-Day Hospital Readmission
I recently had a long conversation with my cardio doc about this topic. He didn't have anything major to input on my similar claims about my using CPAP, however now I can email him this link. It will be interesting to see what his response is. Thanks. SNO
_________________
Mask: AirFit™ F10 Full Face Mask with Headgear |
Additional Comments: Sleepyhead software v.0.9.8.1 Open GL and Encore Pro v2.2. |
I like my ResMed AirFit F10 FFM - reasonably low leaks for my ASV therapy. I'm currently using a PR S1 AutoSV 960P Advanced. I also keep a ResMed S9 Adapt as backup. I use a heated Hibernite hose. Still rockin' with Win 7 by using GWX to stop Win 10.
Re: Cardiac Patients: A Reduction in 30-Day Hospital Readmission
307.4 is the overall ICD-9 code to cover sleep studies.
I don't have the cross reference to a corresponding CPT code.
I don't have the cross reference to a corresponding CPT code.
_________________
Mask: Oracle HC452 Oral CPAP Mask |
Humidifier: DreamStation Heated Humidifier |
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV |
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.
Re: Cardiac Patients: A Reduction in 30-Day Hospital Readmission
There has to be a cpt code. It's covered by Medicare as an outpatient service. Wouldn't it more likely be that under drg's the hospital cannot get additional revenue for performing this diagnostic procedure?
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: DreamWear Nasal CPAP Mask with Headgear |
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
- chunkyfrog
- Posts: 34395
- Joined: Mon Jul 12, 2010 5:10 pm
- Location: Nebraska--I am sworn to keep the secret of this paradise.
Re: Cardiac Patients: A Reduction in 30-Day Hospital Readmission
So we can skip the apple, and go right to the mask--or eat the apple too.
--just not at the same time.
--just not at the same time.
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Airsense 10 Autoset for Her |
Re: Cardiac Patients: A Reduction in 30-Day Hospital Readmission
Interestingly enough, this is pretty much exactly me. Six months ago I was hospitalized with an isolated episode of atrial fibrillation. One of the things they tested me for following that was sleep apnea. One horrible night and an AHI of 53 later, here be I.Sleep disordered breathing (SDB) is associated with significant cardiovascular sequelae and positive airway pressure (PAP) has been shown to improve heart failure and prevent the recurrence of atrial fibrillation in cardiac patients with sleep apnea. Patients who are hospitalized with cardiac conditions frequently have witnessed symptoms of SDB but often do not have a diagnosis of sleep apnea. We implemented a clinical paradigm to perform unattended sleep studies and initiate treatment with PAP in hospitalized cardiac patients with symptoms consistent with SDB. We hypothesized that PAP adherence in cardiac patients with SDB would reduce readmission rates 30 days after discharge.
_________________
Machine: DreamStation Auto CPAP Machine with Heated Humidifier |
Mask: Nuance & Nuance Pro Nasal Pillow CPAP Mask with Gel Nasal Pillows |
Humidifier: DreamStation Heated Humidifier |
Re: Cardiac Patients: A Reduction in 30-Day Hospital Readmission
I think what Stage0 was saying is the HST is not covered while "in a Hospital" and yea that might amount to double billing?Janknitz wrote:There has to be a cpt code. It's covered by Medicare as an outpatient service. Wouldn't it more likely be that under drg's the hospital cannot get additional revenue for performing this diagnostic procedure?
It is not so bad to do this as a service to the patient. Every cardiac doc should be referring his patients for a sleep study. I would leave the doc today if they didn't.