RT Journal Article
SR Electronic
T1 Long-term survival following initiation of home non-invasive ventilation: a European study
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP thoraxjnl-2019-214204
DO 10.1136/thoraxjnl-2019-214204
A1 Maxime Patout
A1 Elodie Lhuillier
A1 Georgios Kaltsakas
A1 Amira Benattia
A1 Johan Dupuis
A1 Gill Arbane
A1 Pierre-Louis Declercq
A1 Michelle Ramsay
A1 Philip Marino
A1 Luis-Carlos Molano
A1 Elise Artaud-Macari
A1 Catherine Viacroze
A1 Joerg Steier
A1 Abdel Douiri
A1 Jean-Francois Muir
A1 Antoine Cuvelier
A1 Patrick Brian Murphy
A1 Nicholas Hart
YR 2020
UL http://thorax.bmj.com/content/early/2020/09/06/thoraxjnl-2019-214204.abstract
AB 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.