Noninvasive ventilation at home reduces mortality in COPD with CRF.

OBJECTIVES

Patients with chronic respiratory failure resulting from chronic obstructive pulmonary disease (COPD-CRF) have limited treatment options and poor health outcomes. We examined the effect of noninvasive ventilation at home (NIVH) treatment on all-cause mortality, hospitalizations, and emergency department (ED) visits.

STUDY DESIGN

Retrospective cohort study.

METHODS

Using Medicare claims data between 2012 and 2017, we divided patients with COPD-CRF into a treatment group, defined by NIVH receipt within 2 months of CRF diagnosis, and a control group without NIVH receipt in the entire follow-up period. We modeled time to death, first hospitalization, and first ED visit. Cox regressions were performed, mitigating selection bias using stabilized inverse probability of treatment weights with regression controls. Sensitivity analyses with time-varying exposure to NIVH were conducted on the full sample irrespective of treatment timing.

RESULTS

We identified 410 patients treated with NIVH and 36,247 controls. We observed a reduced risk of hospitalizations (HR, 0.790; 95% CI, 0.592-0.988), ED visits (HR, 0.571; 95% CI, 0.457-0.686), and mortality (HR, 0.617; 95% CI, 0.462-0.772). The benefit of NIVH diminished over time for mortality and ED visits but remained constant for hospitalizations. However, no survival benefit was observed in the sensitivity analyses that accounted for immortal-time bias; further exploration suggests that earlier NIVH treatment following CRF diagnosis may be an important factor in improving survival outcomes.

CONCLUSIONS

Patients with COPD-CRF who received NIVH had statistically significant reductions in hospitalizations and ED visits compared with patients not treated with NIVH. Further research is needed to examine the effect of NIVH on mortality.