Post-Discharge non-invasive ventilation for hypercapnic respiratory failure: Outcomes in a Rural Cohort.

Abstract

Patients with acute-on-chronic hypercapnic respiratory failure suffer from recurrent readmissions due to acute exacerbations. These patients carry higher readmission and mortality rates compared to the general population. We aimed to delineate the outcomes of patients discharged on non-invasive ventilation. A cross-sectional study was conducted. One hundred nine patients with acute-on-chronic hypercapnic respiratory failure were evaluated and qualified for non-invasive ventilation at discharge. Adherence data was collected post-discharge and the following outcomes were evaluated: 12-month mortality, 6-month hospital readmission, and emergency department visits in patients who were adherent with non-invasive ventilation therapy versus non-adherent and controls. Of the 95 patients discharged on non-invasive ventilation, 25 patients (26%) were found to be adherent to post-discharge home non-invasive ventilation. The adherent group had significantly lower 12-month mortality (p=0.022). Survival benefit persisted on multivariate analysis with the Cox regression model adjusting for comorbidities and demographics (HR = 0.05, p=0.04). The study also observed reduced emergency department visits in the non-invasive ventilation-adherent group compared to the non-adherent (3% vs 17%) [p=0.049] and controls (3% vs 25%) [p=0.024]. Hypercapnic respiratory failure patients discharged home with non-invasive ventilation in the adherent group had significantly lower mortality and emergency department visits. Apart from mask intolerance, low health literacy and transfer to skilled nursing facilities were identified as major reasons for non-adherence.