A retrospective observational study on home non-invasive ventilation: a perspective of multimorbidity

Introduction: Knowledge on the prevalence and impact of a multimorbid aetiology of chronic respiratory failure (CRF) on NIV use and survival is sparse. Aims and objectives: Our aim was to describe the clinical conditions leading to home-NIV, adherence and survival, with a special focus on multimorbidity. We hypothesized that patients with multimorbid CRF have a worse prognosis than those with a single disease causing CRF. Methods: We analysed patients treated with home-NIV in Turku University Hospital between 2004-2014. The indications for NIV implementation were re-evaluated. Patients were categorized as obstructive airway disease (OAD); obesity hypoventilation syndrome (OHS); neuromuscular disease (NMD); chest wall diseases (CWD); sleep apnoea (SA); interstitial lung diseases (ILD); malignancy; other, multimorbid and acute. Patients in the acute group were set up on home-NIV during an acute illness, but later did not meet the criteria for CRF. Data on ventilator settings and NIV-use were collected. Survival of the groups was analysed. Results: 1,281 patients were included. The groups in order of magnitude were SA (26%), multimorbid (17%), OAD (16%), OHS (11%), NMD (10%), acute (8%), CWD (4%), ILD (3%), other (3%) and malignancy (2%). The most frequent combinations were OAD-SA (26%), NMD-SA (25%) and CWD-SA (11%). Mean NIV-use was 6.0 h/d (SD 4.4), median treatment duration 410 (IQR 120-1021) days and median survival 4.5 years (95% CI 3.6-5.4). Adherence, treatment duration or survival did not differ between uni- or multimorbid CRF. Conclusions: Home-NIV is used in a variety of diseases. 17% had a multimorbid origin of CRF, but it was not associated with lower adherence or survival.