Introduction Although home non-invasive ventilation (NIV) is increasingly used to manage patients with chronic ventilatory failure, there are limited data on the long-term outcome of these patients. Our aim was to report on home NIV populations and the long-term outcome from two European centres.
Methods Cohort analysis including all patients established on home NIV from two European centres between 2008 and 2014.
Results Home NIV was initiated in 1746 patients to treat chronic ventilatory failure caused by (1) obesity hypoventilation syndrome±obstructive sleep apnoea (OHS±OSA) (29.5%); (2) neuromuscular disease (NMD) (22.7%); and (3) obstructive airway diseases (OAD) (19.1%). Overall cohort median survival following NIV initiation was 6.6 years. Median survival varied by underlying aetiology of respiratory failure: rapidly progressive NMD 1.1 years, OAD 2.7 years, OHS±OSA >7 years and slowly progressive NMD >7 years. Multivariate analysis demonstrated higher mortality in patients with rapidly progressive NMD (HR 4.78, 95% CI 3.38 to 6.75), COPD (HR 2.25, 95% CI 1.64 to 3.10), age >60 years at initiation of home NIV (HR 2.41, 95% CI 1.92 to 3.02) and NIV initiation following an acute admission (HR 1.38, 95% CI 1.13 to 1.68). Factors associated with lower mortality were NIV adherence >4 hours per day (HR 0.64, 95% CI 0.51 to 0.79), OSA (HR 0.51, 95% CI 0.31 to 0.84) and female gender (HR 0.79, 95% CI 0.65 to 0.96).
Conclusion The mortality rate following initiation of home NIV is high but varies significantly according to underlying aetiology of respiratory failure. In patients with chronic respiratory failure, initiation of home NIV following an acute admission and low levels of NIV adherence are poor prognostic features and may be amenable to intervention.
- non invasive ventilation
- sleep apnoea
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Contributors MP: conception, acquisition, analysis, interpretation, drafting the work. EL, AB, JD, MR: acquisition, interpretation. GK, P-LD, GA, PM, L-CM, EA-M, CV, JS, JFJFMM, AC, PBM, NH: conception, interpretation, critical revision. AD: analysis, interpretation, critical revision.
Funding JS' contributions were partially supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Competing interests MP reports personal fees from ResMed, grants and non-financial support from Fisher & Paykel, non-financial support from MSD, non-financial support and personal fees from Asten, grants from ADIR Association, grants from B&D Electromedical, personal fees from Philips Respironics, and personal fees and non-financial support from Chiesi, outside the submitted work. EL reports non-financial support from Asten, outside the submitted work. JD is an employee of Asten. AD reports grants from Philips Respironics, outside the submitted work. NH reports grants from Guy’s and St Thomas’ Charity, during the conduct of the study, grants from Philips Respironics, non-financial support from Philips Respironics RT Meeting (MYOTRACE), personal fees from Fisher & Paykel, grants from ResMed, grants from B&D Electromedical, and grants from Fisher & Paykel, outside the submitted work. In addition, NH has a patent MYOTRACE pending and is on the Pulmonary Research Advisory Board for Philips. NH’s research group has received unrestricted grants (managed by Guy’s and St Thomas’ Foundation Trust) from Philips Respironics, Philips, ResMed, Fisher & Paykel and B&D Electromedical. Philips Respironics is contributing to the development of the MYOTRACE technology. PBM reports grants and personal fees from Philips Respironics, grants and personal fees from ResMed, and grants and personal fees from B&D Electromedical, outside the submitted work. GK, PL-D, AB, MR, GA, PM, L-CM, CV, JS, JFM and AC have nothing to disclose.
Patient consent for publication Not required.
Ethics approval The study was approved by the local ethic committee of Rouen University Hospital, France (#E2017-21) and registered as a service evaluation at Guy’s and St Thomas’ NHS Trust, London, UK (#7511).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data will be available upon reasonable request to the corresponding author.
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