Abstract
Background Studies on the survival of patients with home mechanical ventilation (HMV) are sparse. We aimed to analyse the impact of controlled hypercapnia on survival over 27 years among HMV patients in Sweden.
Study design and methods Population-based cohort study of adult patients starting HMV in the Swedish Registry for Respiratory Failure (Swedevox) during 1996–2022 cross-linked with the National Cause of Death registry. Mortality risk factors were analysed using crude and multivariable Cox regression models, including adjustments for anthropometrics, comorbidities, the underlying diagnosis causing CRF, and the control of hypercapnia (PaCO2≤6.0 kPa) at follow-up.
Results We included 10 190 patients (50.1% women, age 62.9±14.5 years). Control of hypercapnia at follow-up after 1.3±0.9 years was associated with lower mortality, HR 0.74 (95% confidence interval 0.68–0.80), and the association was strongest in those with pulmonary disease, restrictive thoracal disease (RTD), obesity hypoventilation syndrome (OHS) and amyotrophic lateral sclerosis (ALS). Predictors for increased mortality included age, Charlson comorbidity index, supplemental oxygen therapy, and acute start of HMV therapy. Median survival varied between 0.8 years (0.8–0.9 (n=1401)) for ALS and 7.6 years (6.9–8.6 (n=1061)) for neuromuscular disease. Three-year survival decreased from 76% (71–80) 1996–98 to 52% (50–55) 2017–19. When adjusting for underlying diagnosis and age, the association between start year and decreased survival disappeared, HR 1.00 (0.99–1.01).
Conclusion Controlling PaCO2 is a key treatment goal for survival in HMV therapy. Survival differed markedly between diagnosis and age groups, and survival rates have declined as the patient group has aged.
Footnotes
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Conflict of interest: No author reports any conflicts of interest related to this work. Outside this work, AP reports honoraria from ResMed for lectures and is member of the national quality register for respiratory insufficiency, Swedevox, ME reports a research grant from ResMed and personal fees from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche and is chair for the national quality register for respiratory insufficiency, Swedevox, ML reports honoraria from Amgen, Astra Zeneca and Novo Nordic for lectures, JS reports honoraria for lectures from Astra Zeneca, Boeringer Ingelheim, Chiesi, and Novartis, LG is shareholder of a company which owns a patent for pharmacological treatment in sleep apnea licensed to Desitin GMBH, has received honorary from Onera for medical advisory board, reports honoraria for lectures from ResMed, Philips, Lundbeck and Astra Zeneca for lectures and presentations, and is chair for the national sleep apnea quality registry SESAR, and is member of ERS Assembly 4 and ESRS examination committee.
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- Received May 5, 2024.
- Accepted June 26, 2024.
- Copyright ©The authors 2024
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