Non-invasive ventilation at home improves survival and decreases healthcare utilization in medicare beneficiaries with Chronic Obstructive Pulmonary Disease with chronic respiratory failure

Frazier, William D.; Murphy, Richard J.; Eijndhoven, Emma van

doi:10.1016/j.rmed.2020.106291

Cited by 14 publications

(11 citation statements)

References 28 publications

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“…Treatment durations and survival of our COPD patients were in line with other studies even though our patients were older (on average 74.5 vs 62.2–70.6 years) [ 2 , 26 – 29 ], and had many co-morbidities. Our patients’ hypercapnia was similar to many studies [ 2 , 27 , 28 ]; in only one study was the hypercapnia markedly lower (48.5 mmHg = 6.5 kPa) [ 29 ].…”

Section: Discussionsupporting

confidence: 88%

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The prevalence of non-invasive ventilation and long-term oxygen treatment in Helsinki University Hospital area, Finland

2022

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Background Chronic respiratory failure (CRF) can be treated at home with non-invasive ventilation (NIV) and/or long-term oxygen (LTOT). The prevalence of these treatments is largely unknown. We aimed to clarify the prevalence and indications of the treatments, and the three-year mortality of the treated patients in the Helsinki University Hospital (HUH) area in Finland. Methods In this retrospective study we analyzed the prevalence of adult CRF patients treated with NIV and/or LTOT on 1.1.2018 and followed these patients until 1.1.2021. Data collected included the underlying diagnosis, patient characteristics, information on treatment initiation and from the last follow-up visit, and mortality during the three-year follow-up. Patients with home invasive mechanical ventilation or sleep apnea were excluded. Results On 1.1.2018, we had a total of 815 patients treated with NIV and/or LTOT in the Helsinki University Hospital (HUH) area, with a population of 1.4 million. The prevalence of NIV was 35.4 per 100,000, of LTOT 24.6 per 100,000 and of the treatments combined 60.0 per 100,000. Almost half, 44.5%, were treated with NIV, 41.0% with LTOT, and 14.4% underwent both. The most common diagnostic groups were chronic obstructive pulmonary disease (COPD) (33.3%) and obesity-hypoventilation syndrome (OHS) (26.6%). The three-year mortality in all patients was 45.2%. In the COPD and OHS groups the mortality was 61.3% and 21.2%. In NIV treated patients, the treatment durations varied from COPD patients 5.3 years to restrictive chest wall disease patients 11.4 years. The age-adjusted Charlson co-morbidity index (ACCI) median for all patients was 3.0. Conclusions NIV and LTOT are common treatments in CRF. The prevalence in HUH area was comparable to other western countries. As the ACCI index shows, the treated patients were fragile, with multiple co-morbidities, and their mortality was high. Treatment duration and survival vary greatly depending on the underlying diagnosis.

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Section: Discussionsupporting

confidence: 88%

“…However, recent studies have shown positive impact on COPD patients’ long-term survival with NIV. In studies, NIV-treated COPD patients’ one year mortality was 12–28% and in control group 33–46% [ 2 , 26 ], and three and four year mortalities, 43.9–45.5%[ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

The prevalence of non-invasive ventilation and long-term oxygen treatment in Helsinki University Hospital area, Finland

2022

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“…The findings from the clinical studies described here have been substantiated by Frazier et al 13 using the Medicare Limited Data Set (2012-2018). They compared 517 patients with COPD started on NIV within 2 months of receiving a diagnosis of chronic respiratory failure vs 511 patients with COPD matched for demographic and clinical characteristics but who were not started on NIV.…”

Section: Current Evidence/guidelinessupporting

confidence: 76%

Optimal NIV Medicare Access Promotion: Patients With COPD

Hill

Criner

Branson

et al. 2021

Chest

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This document summarizes the work of the COPD Technical Expert Panel working group.For patients with COPD, the most pressing current coverage barriers identified were onerous diagnostic requirements focused on oxygenation (rather than ventilation) and difficulty obtaining bilevel devices with backup rate capabilities. Because of these difficulties, many patients with COPD were instead sometimes prescribed home mechanical ventilators. Critical evidence supports changes to current policies, including randomized controlled trial evidence suggesting a mortality benefit from bilevel positive airway pressure with backup rate and updated clinical practice guidelines from the American Thoracic Society as well as the European Respiratory Society. To achieve optimal access to noninvasive ventilation for patients with COPD, we make the following key recommendations: (1) removal of the need for overnight oximetry testing; (2) the ability to initiate therapy using bilevel devices with backup rate capability; and (3) increased duration of time to meet adherence criteria (ie, a second 90-day trial period) in those patients actively engaged in their care. Clear guidelines based on medical necessity are also included for patients who require initiation of or switch to a home mechanical ventilator.Adoption of these proposed recommendations would result in the right device, for the right type of patient with COPD, at the right time. Finally, we emphasize the need for adequate clinical support during initiation and maintenance of home noninvasive ventilation in such patients.

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“…15 The primary outcome was striking, with a new gold standard end point showing a 36% relative reduction in 1-year all-cause mortality (12% NIV vs 33% control subjects), and a similar benefit was retrospectively confirmed by using the Medicare Limited Data Set (2012-2018). 16 As noted previously in the Agency for Healthcare Research Quality report of NIV in the home, for COPD, BPAP S/T reduced dyspnea and mortality and increased activities of daily living, whereas both BPAP S/T and HMV reduced hospitalizations. 5 In other guidelines, a European Respiratory Society Task Force in 2019 and an American Thoracic Society subcommittee in 2020 both suggested reduced mortality or rehospitalization using home NIV for patients with stable hypercapnic COPD following hospitalization for an exacerbation.…”

Section: Copdmentioning

confidence: 74%

Executive Summary

Owens

Wolfe²,

Benditt³

et al. 2021

Chest

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The current national coverage determinations (NCDs) for noninvasive ventilation for patients with thoracic restrictive disorders, COPD, and hypoventilation syndromes were formulated in 1998. New original research, updated formal practice guidelines, and current consensus expert opinion have accrued that are in conflict with the existing NCDs. Some inconsistencies in the NCDs have been noted, and the diagnostic and therapeutic technology has also advanced in the last quarter century. Thus, these and related NCDs relevant to bilevel positive airway pressure for the treatment of OSA and central sleep apnea need to be updated to ensure the optimal health of patients with these disorders. To that end, the American College of Chest Physicians organized a multisociety (American Thoracic Society, American Academy of Sleep Medicine, and American Association for Respiratory Care) effort to engage experts in the field to: (1) identify current barriers to optimal care; (2) highlight compelling scientific evidence that would justify changes from current policies incorporating best evidence and practice; and (3) propose suggestions that would form the basis for a revised NCD in each of these 5 areas (thoracic restrictive disorders, COPD, hypoventilation syndromes, OSA, and central sleep apnea). The expert panel met during a 2-day virtual summit in October 2020 and subsequently crafted written documents designed to achieve provision of "the right device to the right patient at the right time." These documents have been endorsed by the participating societies following peer review and publication in CHEST and will be used to inform efforts to revise the current NCDs.

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Non-invasive ventilation at home improves survival and decreases healthcare utilization in medicare beneficiaries with Chronic Obstructive Pulmonary Disease with chronic respiratory failure

Cited by 14 publications

References 28 publications

The prevalence of non-invasive ventilation and long-term oxygen treatment in Helsinki University Hospital area, Finland

The prevalence of non-invasive ventilation and long-term oxygen treatment in Helsinki University Hospital area, Finland

Optimal NIV Medicare Access Promotion: Patients With COPD

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