Noninvasive Home Ventilation Linked to Lower Risk of Death, ER Visits

Marta Figueiredo, PhD avatar

by Marta Figueiredo, PhD |

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Noninvasive ventilation at home, NIVH

Noninvasive ventilation at home, known as NIVH, is associated with a significantly lower risk of death, hospitalization, and emergency room (ER) visits among chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure, according to a study based on Medicare data.

Notably, the NIVH-associated reduced risk of hospitalization was sustained over the seven-year study period, whereas risk benefits regarding mortality and ER visits faded after about two years.

These findings add to the body of evidence showing the benefits of noninvasive home ventilation in this patient population, and therefore further supporting its use. The use of NIVH also was recommended in a recently published national practice guideline by the American Thoracic Society.

“This study is the first of its kind published in the U.S. and represents a significant milestone in our mission of educating the medical community on the benefits of NIVH,” Casey Hoyt, the co-founder and CEO of Viemed Healthcare, the study’s sponsor, said in a press release. Of note, Viemed is a home medical equipment supplier that provides post-acute respiratory care services in the U.S.

“The data supports that NIVH is the best in class treatment for chronic respiratory failure consequent to COPD,” Hoyt said, adding that the company was “excited to share the results of this study with not only our physician referral sources but with our colleagues and payors throughout the industry.”

The study, “Non-invasive ventilation at home improves survival and decreases healthcare utilization in medicare beneficiaries with Chronic Obstructive Pulmonary Disease with chronic respiratory failure,” was published in the journal Respiratory Medicine.

People who develop COPD-associated chronic respiratory failure (COPD-CRF) are at a high risk for poor health outcomes, including mortality. Current treatment is primarily supportive, and interventions such as NIVH “are sometimes used to mitigate the adverse outcomes seen in patients with COPD-CRF, including the risk of death,” the researchers wrote.

NIVH comprises breathing support administered at home through a face or nasal mask. It helps reduce patients’ respiratory rates and keeps oxygen and carbon dioxide levels stable.

Several studies and clinical trials have highlighted an association between NIVH use and reduced mortality, healthcare use, and hospitalizations in people with COPD-CRF.

However, “NIVH remains infrequently used in the U.S.,” the team wrote. The researchers noted that the U.S. Department of Health and Human Services estimated that only 3% of adults diagnosed with COPD-CRF received noninvasive ventilation at home in 2017.

The researchers hypothesized that the slow adoption of NIVH in the U.S. may be associated in part with older clinical data suggesting that the therapy had little to no benefit in COPD-CRF. Additionally, the fact that NIVH’s benefits have been mainly shown in European trials and rarely in U.S. populations is likely a factor, the researchers said.

Now, William Frazier, MD, Viemed’s chief medical officer, together with Precision Health Economics, a bio-statistical and analytics firm, evaluated the associations between NIVH use and survival, hospitalizations, and ER visits in COPD-CRF Medicare beneficiaries.

The team retrospectively analyzed data from the Medicare Limited Data Set from 2012 to 2018. Altogether, 517 eligible patients (mean age of 70.6 years) who received NIVH within two months of their CRF diagnosis were identified, along with 511 patients (mean age of 70.9 years), matched for demographic and clinical features, who did not receive NIVH after CRF diagnosis (controls).

The study’s main goal was to assess death from all causes following CRF diagnosis. Secondary goals included time to first hospital admission and time to first ER visit.

The results showed that NIVH use resulted in clinically meaningful and statistically significant benefits in this patient population. Specifically, patients treated at home with noninvasive ventilation had a 50% lower risk of all-cause death, a 28% reduced risk of hospitalizations, and a 52% lower risk of ER visits at CRF diagnosis, compared with patients not receiving NIVH.

In addition, one year after CRF diagnosis, a smaller proportion of patients given NIVH had died (28% vs. 46%), been hospitalized (55% vs. 67%), and visited the ER (72% vs. 92%), compared with those in the control group.

These differences reflected a one-year relative risk reduction of 39% for mortality, 17% for hospitalizations, and 22% for ER visits with NIVH use.

Notably, the observed survival benefits were consistent with those reported in previous trials and are “highly clinically significant, as currently the only COPD-CRF treatment with a larger mortality reduction is smoking cessation,” the researchers wrote.

Moreover, the NIVH-associated risk reduction remained constant for hospitalizations throughout the seven-year study period. It diminished over time, however, for mortality and ER visits, showing no risk benefit after about two years.

Based on these data, the team estimated that treating COPD-CRF patients with NIVH could drop the number of deaths by 135,000 per year, hospitalizations by 64,000 per year, and ER visits by 151,000 per year.

“Our findings suggest NIVH could be an important treatment option for patients with COPD-CRF, and more patients may benefit from the use of NIVH than the small number currently being prescribed this therapy,” the researchers concluded.