Impact of remote-monitored home non-invasive ventilation on patient outcomes: a retrospective cohort study

Abstract

Introduction Use of home non invasive ventilation (NIV) to treat persistent hypercapnic respiratory failure in patients with stable chronic obstructive pulmonary disease (COPD) effectively reduces readmission rates and mortality compared with standard therapy. Traditional workflows around the initiation and management of NIV include elective admission for therapy initiation and frequent face to face clinic visits for follow up, but use of telemedicine offers an alternative approach. Aim This retrospective cohort study evaluated the clinical efficacy and health resource use impact of a remote monitoring approach to the initiation and monitoring of home NIV. Methods Individuals with COPD, COPD obstructive sleep apnoea or obesity related respiratory failure who were started on remote-monitored home NIV from July 2016 to December 2020 were included. Data were obtained from electronic health records. The primary outcome was healthcare utilisation (hospital admissions and average number of bed days) in the 12 months after versus 12 months before starting NIV; secondary endpoints included 2 year survival and time to readmission, and blood gas analysis. Results In the 12 months after versus before NIV initiation, there was a significant reduction in the mean number of admissions (1.0± 2.1 vs. 1.4± 2.1; p<0.0001) and occupied bed days (9.6± 26.8 vs. 17.2± 27.5; p<0.0001); results were consistent across NIV indications. Time to first readmission (hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.58 – 2.8; p<0.001) and time to death (HR 2.25, 95% CI 1.51 – 3.34; p<0.0001) were significantly worse in NIV non users versus users, but did not differ by deprivation quintile. Blood gas analysis showed that NIV significantly reduced carbon dioxide pressure and bicarbonate compared with before NIV. Conclusions A technology assisted service model for the remote initiation and monitoring of home NIV therapy for individuals with chronic hypercapnic respiratory failure was feasible, had a beneficial effect on healthcare utilisation and outcomes, and offset typical adverse relative survival outcomes associated with deprivation.