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Home oxygen therapy (HOT) for people with chronic heart failure: a randomised controlled trial

We aimed to see if home oxygen therapy improved the quality of life of people with chronic heart failure. The trial was stopped early because of low adherence to the therapy, but no evidence of improvements in quality of life or symptoms were seen.

Why did we do this research?

Patients with severe chronic heart failure suffer from breathlessness that may ruin their quality of life. Partly because patients with severe lung disease benefit from home oxygen therapy (HOT), patients with severe heart failure are often prescribed home oxygen. However, oxygen therapy can be burdensome. It limits mobility, it can cause soreness around the nose and the equipment is noisy. There is no evidence to support its use in patients with heart failure.

What did we do?

The HOT trial was designed to measure any beneficial effects on quality of life measured with the Minnesota Living with Heart Failure questionnaire. We allocated, at random, 114 patients with severely symptomatic heart failure either to receive home oxygen for 15 hours a day or not to receive oxygen therapy. All participants continued to receive the best medical therapy for their condition.

Who was involved?

We recruited patients from heart failure outpatient clinics in hospital or the community, in a range of urban and rural settings. The average age of patients was 70 years, and 70% of patients were men. 

What did we find?

Only 11% of patients reported that they used the oxygen for the full 15 hours a day, so the trial was stopped early. We found no evidence that home oxygen improved patients’ quality of life, symptoms or any other measurement of severity of heart failure. There was a small improvement in survival with oxygen, but the difference was not statistically significant.

What have we learned? 

Few patients with severe heart failure at rest, following exercise and during an overnight sleep test have hypoxia. There is no evidence that long term oxygen therapy, although safe, improves the symptoms, prognosis or severity of heart failure in patients with severe chronic heart failure at 6 months. We found no evidence to support the use of home oxygen therapy in patients with heart failure.

The early termination of the study was because of poor adherence to the prescription of 15 hours of oxygen per day. It may be that shorter periods of exposure might have been effective, either in terms of symptom relief or in terms of preventing hospitalisation. Further studies might identify whether or not having emergency oxygen available at home would reduce the need for admission to hospital.

Outputs

Clark AL, Johnson M, Fairhurst C, Torgerson D, Cockayne S, Rodgers S, et al. Does home oxygen therapy (HOT) in addition to standard care reduce disease severity and improve symptoms in people with chronic heart failure? A randomised trial of home oxygen therapy for patients with chronic heart failure. Health Technol Assess 2015;19(75) https://doi.org/10.3310/hta19750

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