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. 2023 Aug 29:34:100717.
doi: 10.1016/j.lanepe.2023.100717. eCollection 2023 Nov.

Health trajectories before initiation of non-invasive ventilation for chronic obstructive pulmonary disease: a French nationwide database analysis

Jean-Louis Pepin  1 , Pauline Lemeille  2 , Hélène Denis  2 , Anne Josseran  3 , Florent Lavergne  3 , Arnaud Panes  2 , Sébastien Bailly  1 , Alain Palot  4 , Arnaud Prigent  5 ; medXcloud group
Affiliations

Health trajectories before initiation of non-invasive ventilation for chronic obstructive pulmonary disease: a French nationwide database analysis

Jean-Louis Pepin et al. Lancet Reg Health Eur. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the most common indication for long-term domiciliary non-invasive ventilation (NIV) but there is uncertainty in data supporting current guidelines. This study described health trajectories before initiation of at-home NIV in people with COPD, and compared mortality outcomes between groups with different pre-NIV health trajectories.

Methods: Data were from the French national health insurance reimbursement system database for individuals with COPD aged ≥40 years and ≥1 reimbursement for NIV between 1 January 2015 and 31 December 2019. Common health trajectories were determined using time sequence analysis through K-clustering (TAK analysis).

Findings: Data from 54,545 individuals were analysed; the population was elderly (median age 70 years) with multiple comorbidities. Four clusters were generated. Cluster 1 (n = 35,975/54,545; 66%) had NIV initiated in ambulatory settings or after the first acute event/exacerbation. Cluster 2 (6653/54,545; 12%) started NIV after ≥2 severe exacerbations in the previous 6 months. Cluster 3 (11,375/54,545; 21%) started NIV after frequent severe COPD-related exacerbations in the previous year. Cluster 4 (652/54,545; 1%) started NIV after many long-lasting severe exacerbations. The four clusters differed in age, sex, comorbidities, pre-NIV investigations, and prescriber/location of NIV initiation. Mortality differed significantly between clusters: highest in Cluster 4 and lowest in Cluster 1.

Interpretation: The significant heterogeneity in clinical initiation of NIV probably reflects the current lack of strong evidence and guideline recommendations. Knowledge about the characteristics and outcomes in different clusters should be used to address inequities and facilitate more consistent and personalised use domiciliary NIV in COPD.

Funding: JLP and SB are supported by the French National Research Agency in the framework of the "Investissements d'avenir" program (ANR-15-IDEX-02) and the "e-health and integrated care and trajectories medicine and MIAI artificial intelligence (ANR-19-P3IA-0003)" Chairs of excellence from the Grenoble Alpes University Foundation. This work was supported by ResMed.

Keywords: Chronic obstructive pulmonary disease; Comorbidities; Health database; Health trajectories; Non-invasive ventilation.

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Conflict of interest statement

JLP has received lecture fees or conference travel grants from ResMed, Philips, AstraZeneca, Jazz Pharmaceuticals, Agiradom and Bioprojet, and has received unrestricted research funding from ResMed, Philips, GlaxoSmithKline, Bioprojet, Fondation de la Recherche Medicale (Foundation for Medical Research), Direction de la Recherche Clinique du CHU de Grenoble (Research Branch Clinic CHU de Grenoble), and fond de dotation “Agir pour les Maladies Chroniques” (endowment fund “Acting for Chronic Diseases”). FL and AJ are employees of ResMed. PL, HD and AP are employees of HEVA and their participation in this study was funded by ResMed. APa has received consulting fees from ResMed. APr has received investigator fees for clinical trials funded by ResMed. SB has no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
TAK-medoid methodology.
Fig. 2
Fig. 2
Trajectories in the year before initiation of at-home non-invasive ventilation by patient cluster. The end of the trajectory is the initiation of non-invasive ventilation (NIV); the grey rectangle with a house symbol in Cluster 1 indicates individuals who had initiation of NIV at home or during private practice consultation (ambulatory settings) without any prior hospitalisation or exacerbation (n = 11,405; 21%); vertical lines and associated text indicate proportion of participants and median timing of treatments and procedures prior to NIV initiation. (A) Trajectories in the year before initiation of at-home non-invasive ventilation in cluster 1. (B) Trajectories in the year before initiation of at-home non-invasive ventilation in cluster 2. (C) Trajectories in the year before initiation of at-home non-invasive ventilation in cluster 3. (D) Trajectories in the year before initiation of at-home non-invasive ventilation in cluster 4.
Fig. 2
Fig. 2
Trajectories in the year before initiation of at-home non-invasive ventilation by patient cluster. The end of the trajectory is the initiation of non-invasive ventilation (NIV); the grey rectangle with a house symbol in Cluster 1 indicates individuals who had initiation of NIV at home or during private practice consultation (ambulatory settings) without any prior hospitalisation or exacerbation (n = 11,405; 21%); vertical lines and associated text indicate proportion of participants and median timing of treatments and procedures prior to NIV initiation. (A) Trajectories in the year before initiation of at-home non-invasive ventilation in cluster 1. (B) Trajectories in the year before initiation of at-home non-invasive ventilation in cluster 2. (C) Trajectories in the year before initiation of at-home non-invasive ventilation in cluster 3. (D) Trajectories in the year before initiation of at-home non-invasive ventilation in cluster 4.
Fig. 3
Fig. 3
Kaplan Meier survival curves by patient cluster. NIV, non-invasive ventilation.
See this image and copyright information in PMC

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