Time-to-death in chronic respiratory failure on home mechanical ventilation: a cohort study

Esther I. Schwarz; Mike Mackie; Nick Weston; Laura Tincknell; Gurpreet Beghal; Michael C. F. Cheng; Michelle Ramsay; Eui-Sik Suh; Georgios Kaltsakas; Hina Pattani; Philip Marino; Patrick B. Murphy; Nicholas Hart; Joerg Steier

doi:10.1016/j.rmed.2020.105877

Time-to-death in chronic respiratory failure on home mechanical ventilation: a cohort study

Esther I. Schwarz, Mike Mackie, Nick Weston, Laura Tincknell, Gurpreet Beghal, Michael C. F. Cheng, Michelle Ramsay, Eui-Sik Suh, Georgios Kaltsakas, Hina Pattani, Philip Marino, Patrick B. Murphy, Nicholas Hart, Joerg Steier

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Abstract

Background and objective: Home mechanical ventilation (HMV) is used in heterogeneous conditions underlying chronic hypercapnic respiratory failure, but there are sparse data on long-term clinical outcomes. The aim was to systematically analyse the time and the circumstances of death on HMV. Methods: All-cause mortality data of HMV patients were prospectively collected between 2008 and 2018 in a large tertiary centre. Data were categorised into diagnostic groups including neuromuscular disease (NMD), chest wall disease (CWD), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), overlap syndrome of COPD and OSA (overlap) and other group. The primary outcome was time-to-death from initiation of HMV. Results: 1210 deaths were recorded over a 10-year period. Median time-to-death was 19.5 [6–55] months and differed between groups (Kruskal Wallis p < 0.001). CWD (98.5 [23.5–120] months) and slowly progressive NMD (64.5 [28–120] months) had the longest time-to-death on HMV, while OHS (33 [13–75] months) and overlap syndrome (30.5 [14.5–68.5] months) had a longer median time-to-death than COPD (19.5 [7–42.5] months) and motor neurone disease (7 [3–14] months). Daily adherence to HMV of greater than 4 h/night was associated with better outcomes (10 [3–24] vs. 30 [10–76] months; p < 0.001). 43% with confirmed location of death died outside the hospital. Conclusions: The time-to-death on home mechanical ventilation varies widely across disease groups with chronic respiratory failure and seems to be associated with daily usage time. Trial registration: researchregistry.com UIN: researchregistry4122.

Original language	English
Article number	105877
Journal	Respiratory Medicine
Volume	162
Early online date	13 Jan 2020
DOIs	https://doi.org/10.1016/j.rmed.2020.105877
Publication status	Published - Feb 2020

Keywords

Home mechanical ventilation
Mortality
Chronic respiratory failure
Non-invasive ventilation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.rmed.2020.105877

Time-to-death in_SHWARZ_Epub13Jan2020_GREEN AAMAccepted author manuscript, 276 KBLicence: CC BY-NC-ND

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Schwarz, E. I., Mackie, M., Weston, N., Tincknell, L., Beghal, G., Cheng, M. C. F., Ramsay, M., Suh, E.-S., Kaltsakas, G., Pattani, H., Marino, P., Murphy, P. B., Hart, N., & Steier, J. (2020). Time-to-death in chronic respiratory failure on home mechanical ventilation: a cohort study. Respiratory Medicine, 162, Article 105877. https://doi.org/10.1016/j.rmed.2020.105877

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title = "Time-to-death in chronic respiratory failure on home mechanical ventilation: a cohort study",

abstract = "Background and objective: Home mechanical ventilation (HMV) is used in heterogeneous conditions underlying chronic hypercapnic respiratory failure, but there are sparse data on long-term clinical outcomes. The aim was to systematically analyse the time and the circumstances of death on HMV. Methods: All-cause mortality data of HMV patients were prospectively collected between 2008 and 2018 in a large tertiary centre. Data were categorised into diagnostic groups including neuromuscular disease (NMD), chest wall disease (CWD), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), overlap syndrome of COPD and OSA (overlap) and other group. The primary outcome was time-to-death from initiation of HMV. Results: 1210 deaths were recorded over a 10-year period. Median time-to-death was 19.5 [6–55] months and differed between groups (Kruskal Wallis p < 0.001). CWD (98.5 [23.5–120] months) and slowly progressive NMD (64.5 [28–120] months) had the longest time-to-death on HMV, while OHS (33 [13–75] months) and overlap syndrome (30.5 [14.5–68.5] months) had a longer median time-to-death than COPD (19.5 [7–42.5] months) and motor neurone disease (7 [3–14] months). Daily adherence to HMV of greater than 4 h/night was associated with better outcomes (10 [3–24] vs. 30 [10–76] months; p < 0.001). 43% with confirmed location of death died outside the hospital. Conclusions: The time-to-death on home mechanical ventilation varies widely across disease groups with chronic respiratory failure and seems to be associated with daily usage time. Trial registration: researchregistry.com UIN: researchregistry4122.",

keywords = "Home mechanical ventilation, Mortality, Chronic respiratory failure, Non-invasive ventilation",

author = "Schwarz, {Esther I.} and Mike Mackie and Nick Weston and Laura Tincknell and Gurpreet Beghal and Cheng, {Michael C. F.} and Michelle Ramsay and Eui-Sik Suh and Georgios Kaltsakas and Hina Pattani and Philip Marino and Murphy, {Patrick B.} and Nicholas Hart and Joerg Steier",

year = "2020",

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doi = "10.1016/j.rmed.2020.105877",

language = "English",

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journal = "Respiratory Medicine",

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TY - JOUR

T1 - Time-to-death in chronic respiratory failure on home mechanical ventilation: a cohort study

AU - Schwarz, Esther I.

AU - Mackie, Mike

AU - Weston, Nick

AU - Tincknell, Laura

AU - Beghal, Gurpreet

AU - Cheng, Michael C. F.

AU - Ramsay, Michelle

AU - Suh, Eui-Sik

AU - Kaltsakas, Georgios

AU - Pattani, Hina

AU - Marino, Philip

AU - Murphy, Patrick B.

AU - Hart, Nicholas

AU - Steier, Joerg

PY - 2020/2

Y1 - 2020/2

N2 - Background and objective: Home mechanical ventilation (HMV) is used in heterogeneous conditions underlying chronic hypercapnic respiratory failure, but there are sparse data on long-term clinical outcomes. The aim was to systematically analyse the time and the circumstances of death on HMV. Methods: All-cause mortality data of HMV patients were prospectively collected between 2008 and 2018 in a large tertiary centre. Data were categorised into diagnostic groups including neuromuscular disease (NMD), chest wall disease (CWD), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), overlap syndrome of COPD and OSA (overlap) and other group. The primary outcome was time-to-death from initiation of HMV. Results: 1210 deaths were recorded over a 10-year period. Median time-to-death was 19.5 [6–55] months and differed between groups (Kruskal Wallis p < 0.001). CWD (98.5 [23.5–120] months) and slowly progressive NMD (64.5 [28–120] months) had the longest time-to-death on HMV, while OHS (33 [13–75] months) and overlap syndrome (30.5 [14.5–68.5] months) had a longer median time-to-death than COPD (19.5 [7–42.5] months) and motor neurone disease (7 [3–14] months). Daily adherence to HMV of greater than 4 h/night was associated with better outcomes (10 [3–24] vs. 30 [10–76] months; p < 0.001). 43% with confirmed location of death died outside the hospital. Conclusions: The time-to-death on home mechanical ventilation varies widely across disease groups with chronic respiratory failure and seems to be associated with daily usage time. Trial registration: researchregistry.com UIN: researchregistry4122.

AB - Background and objective: Home mechanical ventilation (HMV) is used in heterogeneous conditions underlying chronic hypercapnic respiratory failure, but there are sparse data on long-term clinical outcomes. The aim was to systematically analyse the time and the circumstances of death on HMV. Methods: All-cause mortality data of HMV patients were prospectively collected between 2008 and 2018 in a large tertiary centre. Data were categorised into diagnostic groups including neuromuscular disease (NMD), chest wall disease (CWD), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), overlap syndrome of COPD and OSA (overlap) and other group. The primary outcome was time-to-death from initiation of HMV. Results: 1210 deaths were recorded over a 10-year period. Median time-to-death was 19.5 [6–55] months and differed between groups (Kruskal Wallis p < 0.001). CWD (98.5 [23.5–120] months) and slowly progressive NMD (64.5 [28–120] months) had the longest time-to-death on HMV, while OHS (33 [13–75] months) and overlap syndrome (30.5 [14.5–68.5] months) had a longer median time-to-death than COPD (19.5 [7–42.5] months) and motor neurone disease (7 [3–14] months). Daily adherence to HMV of greater than 4 h/night was associated with better outcomes (10 [3–24] vs. 30 [10–76] months; p < 0.001). 43% with confirmed location of death died outside the hospital. Conclusions: The time-to-death on home mechanical ventilation varies widely across disease groups with chronic respiratory failure and seems to be associated with daily usage time. Trial registration: researchregistry.com UIN: researchregistry4122.

KW - Home mechanical ventilation

KW - Mortality

KW - Chronic respiratory failure

KW - Non-invasive ventilation

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U2 - 10.1016/j.rmed.2020.105877

DO - 10.1016/j.rmed.2020.105877

M3 - Article

SN - 0954-6111

VL - 162

JO - Respiratory Medicine

JF - Respiratory Medicine

M1 - 105877

ER -

Time-to-death in chronic respiratory failure on home mechanical ventilation: a cohort study

Abstract

Keywords

UN SDGs

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