Noninvasive Ventilation at Home May Reduce Risk of Hospitalization
Noninvasive ventilation at home, known as NIVH, can reduce the risk of hospitalization, emergency department visits, and death in people with chronic obstructive pulmonary disease (COPD) who have trouble getting enough oxygen, new research indicates.
NIVH is a breathing support technique given at home, using a face or nasal mask, that seeks to keep breathing and blood oxygen levels stable.
“Because COPD has no cure, treatment is palliative; goals include reducing mortality and hospitalizations and improving [quality of life],” the researchers wrote.
The findings of this research, reported in “Noninvasive Ventilation at Home Reduces Mortality in COPD With CRF,” show that the use of non-invasive treatment in certain patients led to “statistically significant and clinically meaningful reductions in hospitalizations and [emergency department] visits compared with patients not treated with NIVH,” the researchers wrote.
The study, published in The American Journal of Managed Care, was funded by Viemed Healthcare, which makes medical equipment for NIVH.
“We are very pleased to once again see published evidence that supports the clinical efficacy of NIVH on the highest risk, chronically ill respiratory patients, and are excited to continue to share these results with the medical community,” Casey Hoyt, CEO of Viemed, said in a press release.
Hoyt said these results “confirm the findings of a separate study” that was published late last year, which “used different statistical methods and studied a different patient population than that used in the current study.” Nonetheless, the new findings add to the company’s data supporting the use of its NIVH products, according to Hoyt.
COPD is a chronic inflammatory disease of the lungs, in which the patient’s airways become blocked, leading to cough with mucus, wheezing, and shortness of breath. As the disease progresses to a more severe stage, it can cause chronic respiratory failure, or COPD-CRF, a condition in which the lungs are not able to effectively pass down oxygen and remove carbon dioxide from the bloodstream.
The potential benefits of NIVH in people with COPD-CRF are still being investigated.
Now, a group led by scientists at Viemed conducted an analysis of U.S. Medicare data gathered between 2012 and 2017. Using these data, the team identified 410 people with COPD-CRF who were prescribed NIVH within two months of being diagnosed with CRF. For comparison, the team assessed the outcomes of 36,247 COPD-CRF patients who were never prescribed NIVH (controls).
The team conducted a battery of statistical tests to see whether using NIVH was associated with significantly different outcomes in terms of hospitalizations or mortality.
At one year after the diagnosis, 56.3% of patients prescribed NIVH and 64.6% of controls had been hospitalized. Additionally, 70% of patients given NIVH had visited the emergency department, as compared with 87.7% of controls. Mortality rates at one year after CRF diagnosis were 29.4% among patients given NIVH and 42.4% among controls.
Statistical models indicated that NIVH significantly reduced the risk of hospitalization by about 21%, according to the company’s researchers. The risk of visiting the emergency room also was significantly reduced by approximately 42.9%, as was the risk of death by around 38.3%.
Notably, the benefit of NIVH in terms of emergency room visits and death decreased over time, whereas its benefit in terms of hospitalization appeared to remain stable over similar longer periods.
“After 69 weeks, NIVH no longer showed a survival benefit, and after 81 weeks, it no longer showed a reduced risk of ED [emergency department] visits,” the researchers wrote.
An important caveat of these results is that the statistical models the researchers used rely on certain mathematical assumptions to ensure their accuracy. Analyses indicated that, for the effect of NIVH on mortality and emergency department visits, some of these assumptions might not actually hold true. The team suggested that this may be because the effect appeared to vary with time since diagnosis, stressing a need for more research, especially to evaluate the effect of NIVH on mortality.
“NIVH was associated with lower risks of hospitalizations and [emergency department] visits in patients with COPD-CRF. Further research is needed to examine the effect of NIVH on all-cause mortality,” the team concluded.
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