1119 Retrospective Analysis of the Impact of Mineralocorticoid Receptor Antagonists on Sleep Disordered Breathing in Patients with Systolic Heart Failure

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Abstract Introduction Sleep disordered breathing (SDB) is a common event in heart failure with reduced ejection fraction (HFrEF). It is often seen as a possible contributor of further worsening of heart failure. The implementation of advancing guideline-directed medical therapy (GDMT) is necessary in improving outcomes in patients with HFrEF. Since implementation of Mineralocorticoid receptor antagonists (MRA) to GDMT, it has led to mortality rate reduction in patients with HFrEF. However, the American College of Cardiology mainly recommends it in patients with ejection fraction (EF) of less than 40% based on present trials. This study aims to assess the impact MRA’s regarding the development of SDB in this patient population. Methods TrinetX, an application which collects de-identified patient data, was used to perform this retrospective cohort study. 2 groups were formed, the first group composed of patients with HFrEF with ejection fraction (EF) of less than 40% on GDMT including MRA’s. The second group comprised of similar characteristics except were on GDMT without MRA’s. Age was set at 18 years and older, then propensity score matching was performed. The groups were compared assessing the risk, Risk differences (RD), P-values (p), risk ratio (RR), and confidence intervals (CI). Results The groups were studied over 3 years from initiation of their respective GDMT course. First, mortality occurrence was assessed with risks of 19.4% vs 20.804%, RD 1.403% p< 0.0001, RR 0.933(CI: 0.902, 0.965). Then the occurrence of central sleep apnea was assessed with risks of 0.582% vs 0.365%, RD 0.216% p 0.0003, RR 1.592 (CI: 1.238, 2.049). Finally, the development of obstructive sleep apnea was assessed with risks of 7.92% vs 6.137%, RD 1.783% p< 0.0001, RR1.291 (CI: 1.208, 1.379). Conclusion This study first confirms the already noted mortality benefit of MRA’s in patients with HFrEF. However, it also notes an elevated risk of developing SDB in this at-risk patient population. Thus, providers should have reduced thresholds for evaluating SDB in this patient population. Furthermore, subsequent studies are required to elucidate the mechanism of this phenomenon. Support (if any)

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