Background

Patients with Chronic Obstructive Pulmonary Disease with chronic respiratory failure (COPD-CRF) experience high mortality and healthcare utilization. Non-invasive home ventilation (NIVH) is increasingly used in such patients. We examined the associations between NIVH and survival, hospitalizations, and emergency room (ER) use in COPD-CRF Medicare beneficiaries.

Materials and methods

Retrospective cohort study using the Medicare Limited Data Set (2012–2018). Patients receiving NIVH within two months of CRF diagnosis (treatment group) were matched on demographic and clinical characteristics to patients never receiving NIVH (control group). CRF diagnosis was identified using ICD-9-CM/ICD-10-CM codes. Time to death, first hospitalization, and first ER visit were estimated using Cox regressions.

Results

After matching, 517 patients receiving NIVH and 511 controls (mean age: 70.6 years, 44% male) were compared. NIVH significantly reduced risk of death (aHR: 0.50; 95%CI: 0.36–0.65), hospitalization (aHR: 0.72; 95%CI: 0.52–0.93), and ER visit (aHR: 0.48; 95%CI: 0.38–0.58) at diagnosis. The NIVH risk reduction became smaller over time for mortality and ER visits, but continued to accrue for hospitalizations. One-year post-diagnosis, 28% of treated patients died versus 46% controls. For hospitalizations and ER visits, 55% and 72% treated patients experienced an event, respectively, versus 67% and 92% controls. The relative risk reduction was 39% for mortality, 17% for hospitalizations, and 22% for ER visits. Number needed to treat were 5.5, 9, and 5 to prevent a death, hospitalization, or ER visit one-year post-diagnosis, respectively.

Conclusion

NIVH treatment is associated with reduced risk of death, hospitalizations, and ER visits among COPD-CRF Medicare beneficiaries.

中文翻译：

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家庭无创通气可提高患有慢性阻塞性肺病并慢性呼吸衰竭的医疗保险受益人的生存率并减少医疗保健利用率

背景

慢性阻塞性肺疾病伴慢性呼吸衰竭 (COPD-CRF) 患者的死亡率和医疗利用率较高。无创家庭通气（NIVH）越来越多地用于此类患者。我们研究了 COPD-CRF 医疗保险受益人的 NIVH 与生存、住院和急诊室 (ER) 使用之间的关联。

材料和方法

使用 Medicare 有限数据集（2012-2018）进行回顾性队列研究。CRF 诊断后两个月内接受 NIVH 的患者（治疗组）在人口统计学和临床​​特征上与从未接受过 NIVH 的患者（对照组）进行匹配。使用 ICD-9-CM/ICD-10-CM 代码确定 CRF 诊断。使用 Cox 回归估计死亡时间、首次住院时间和首次急诊就诊时间。

结果

匹配后，对 517 名接受 NIVH 的患者和 511 名对照者（平均年龄：70.6 岁，44% 男性）进行了比较。NIVH 显着降低了死亡风险（aHR：0.50；95%CI：0.36–0.65）、住院风险（aHR：0.72；95%CI：0.52–0.93）和急诊就诊风险（aHR：0.48；95%CI：0.38–0.58） ）在诊断时。随着时间的推移，死亡率和急诊就诊的 NIVH 风险降低幅度越来越小，但住院治疗的风险降低幅度继续增加。诊断一年后，接受治疗的患者中有 28% 死亡，而对照组为 46%。对于住院治疗和急诊室就诊，接受治疗的患者分别有 55% 和 72% 经历过事件，而对照组为 67% 和 92%。死亡率的相对风险降低了 39%，住院治疗的相对风险降低了 17%，急诊室就诊的相对风险降低了 22%。为防止诊断后一年死亡、住院或急诊就诊，需要治疗的人数分别为 5.5、9 和 5。

结论

NIVH 治疗可降低 COPD-CRF 医疗保险受益人的死亡、住院和急诊就诊风险。