1. In patients with stable angina and multiple cardiac risk | Figure 1

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Case Summary

  1. In patients with stable angina and multiple cardiac risk factors, those undergoing myocardial-perfusion cardiovascular magnetic resonance imaging (MRI) compared to invasive angiography and measurement of fractional flow reserve (FFR) underwent fewer coronary revascularization procedures.

  2. Patients in the MRI group experienced major adverse cardiac events at a rate non-inferior to the FFR group.

Evidence Rating Level: 1 (Excellent)

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Background

Ischaemic heart disease including heart failure is the most common cause of death in the world, and the incidence of the condition is rapidly increasing. Heart failure is characterised by symptoms such as fatigue and breathlessness during light activity, as well as disordered breathing during sleep. In particular, sleep disordered breathing, including central sleep apnoea (CSA) and obstructive sleep apnoea, is highly prevalent in people with chronic heart failure.
Purpose: to assess the effects of positive airway pressure (PAP) therapy for people with heart failure who experience CSA.

Methods

We searched the scientific literature for randomised controlled trials (RCTs) that compared the effectiveness of PAP therapy versus usual care in people with heart failure who experience CSA. PAP therapy consisted of continuous PAP and adaptive servo-ventilation, and usual care consisted of medical therapy based on relevant guidelines. The evidence is current to February 2019.

Results

We included 16 RCTs involving a total of 2125 participants. The effect of PAP therapy on all-cause mortality was uncertain. PAP therapy did not reduce cardiac-related mortality, all-cause rehospitalisation, and cardiac-related rehospitalisation compared with usual care. However, PAP therapy showed some indication of an improvement in quality of life scores. Death due to pneumonia (N = 1, 3% of PAP group); cardiac arrest (N = 18, 3% of PAP group); heart transplantation (N = 8, 1% of PAP group); and cardiac worsening were observed in the PAP therapy group, whereas cardiac arrest (N = 16, 2% of usual care group); heart transplantation (N = 12, 2% of usual care group); and cardiac worsening occurred in the usual care group across three trials.

Quality of the Evidence

We assessed the quality of evidence for many outcomes including cardiac-related rehospitalisation as low or very low because variability among studies was high and random sequence generation and blinding of participants and personnel were poorly described.

Conclusion

The effect of PAP therapy on all-cause mortality was uncertain. Although PAP therapy did not reduce the risk of cardiac-related mortality and rehospitalisation, there was some indication of an improvement in quality of life score for heart failure patients with CSA. The evidence was insufficient to determine whether adverse events were more common with PAP than with usual care. These findings were limited by low- or very low-quality evidence. PAP therapy may be worth considering for individuals with heart failure to improve quality of life.

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