Effect of telemonitoring on the rate of dropout during home non-invasive ventilation: a retrospective study using a home care provider database.

Objectives: 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.
Design: Retrospective cohort study.
Setting: Data were obtained from all agencies of a single home care provider in France.
Participants: 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.
Primary and Secondary Outcome Measures: The primary outcome was the rate of NIV dropouts at 1 year (ie, treatment discontinuation, excluding deaths). Secondary outcomes included therapy compliance and leaks.
Results: 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.
Conclusions: 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.
Competing Interests: Competing interests: RLM declares receipt of personal fees from Orkyn-Pharmadom, CGG declares receipt of personal fees from Orkyn-Pharmadom. FK is an employee of Pharmadom-Orkyn. JT is an employee of Air Liquide Healthcare. ACM and MR are employees of Alira Health. FG declares receipt of personal fees from Air Liquide Sante, Asten Sante, Inspire, Bioprojet, ResMed and Sefam, payment for presentations from Asten Sante, Bioprojet, Cidelec, Jazz Pharmaceuticals, Philips Respironics, and ResMed, and non-financial support from Asten Sante. WT declares payment for presentations from Bioprojet and Astra Zeneca and non-financial support from Asten Sante. The authors perceive that these disclosures pose no academic conflict for this study.
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