Department of Internal Medicine and Pneumology, La Cavale Blanche Hospital, CHU de Brest, Brest, France
UMR1304, Universite de Bretagne Occidentale, Brest, France.
BMJ Open. 2024 Oct 4;14(10):e088496. doi: 10.1136/bmjopen-2024-088496.
Telemonitoring (TM) of home non-invasive ventilation (NIV) has been shown to facilitate home/outpatient therapy set-up. However, the impact of long-term TM on therapy dropouts, compliance and leak control has not yet been clearly determined. This study evaluated whether the NIV dropout rate was reduced by TM combined with remote patient support compared with a non-telemonitoring (NTM) pathway.
Retrospective cohort study.
Data were obtained from all agencies of a single home care provider in France.
Adults with chronic respiratory failure (n=659) who started nocturnal NIV between January 2017 and December 2019 and had ≥8 days of NIV therapy (51% male; mean age 68.5±13.8 years; 35.5% on long-term oxygen therapy) were included. The TM group included 275 patients who spent ≥80% of the follow-up using TM, and the NTM group included 384 patients who had 0 to ≤10 days of telemonitoring during follow-up.
The primary outcome was the rate of NIV dropouts at 1 year (ie, treatment discontinuation, excluding deaths). Secondary outcomes included therapy compliance and leaks.
82 patients died during follow-up. Significantly fewer patients in the TM vs NTM group had dropped out of NIV therapy at 1 year (13% vs 34%; p<0.001). After adjustment for age, sex, NIV usage at 1-month follow-up and the main underlying respiratory disease, TM was significantly associated with a lower risk of dropout (HR 0.33, 95% CI 0.23 to 0.49; p<0.001). At 1, 4, 8 and 12 months, a greater proportion of patients in the TM vs NTM group had NIV usage of >4 hours/day and control of leaks.
In patients starting home NIV, TM with home care provider first-line support was associated with a lower therapy dropout rate at 1 year, and better compliance and leak control, compared with standard follow-up.
家庭无创通气（NIV）的远程监测（TM）已被证明有助于家庭/门诊治疗的设置。然而，长期 TM 对治疗中断、依从性和漏气控制的影响尚未明确确定。本研究评估了与非远程监测（NTM）途径相比，TM 联合远程患者支持是否降低了 NIV 脱落率。
回顾性队列研究。
数据来自法国一家家庭护理提供商的所有机构。
2017 年 1 月至 2019 年 12 月期间开始夜间 NIV 的慢性呼吸衰竭成年人（n=659），并接受了≥8 天的 NIV 治疗（51%为男性；平均年龄 68.5±13.8 岁；35.5%接受长期氧疗）。TM 组包括 275 名至少 80%随访期间使用 TM 的患者，NTM 组包括 384 名随访期间仅接受 0 至≤10 天远程监测的患者。
主要结局是 1 年时 NIV 脱落率（即治疗中断，不包括死亡）。次要结局包括治疗依从性和漏气。
82 名患者在随访期间死亡。TM 组较 NTM 组 1 年时停止 NIV 治疗的患者明显减少（13% vs 34%；p<0.001）。调整年龄、性别、1 个月随访时的 NIV 使用情况和主要潜在呼吸疾病后，TM 与较低的脱落风险显著相关（HR 0.33，95%CI 0.23 至 0.49；p<0.001）。在 1、4、8 和 12 个月时，TM 组较 NTM 组有更多的患者每天使用 NIV>4 小时，漏气得到控制。
在开始家庭 NIV 的患者中，与标准随访相比，家庭护理提供商一线支持的 TM 与 1 年内较低的治疗中断率以及更好的依从性和漏气控制相关。
