REINVENT: International Survey on REstrictive thoracic diseases IN long term home noninvasive VENTilation

Background and aimLittle is known about the current use of long-term home non-invasive ventilation (LTHNIV) in restrictive thoracic diseases (RTD), including chest wall and neuromuscular disorders (CWD, NMD). This study aimed to capture the pattern of LTHNIV in RTD patients via a web-based international survey.MethodsThe survey involved ERS Assembly 2.02 (NIV dedicated group) October-December 2019.Results166/748 (22.2%) members from 41 countries responded; 80% were physicians, of whom 43% worked in a respiratory intermediate intensive care unit (RIICU). The NMD:CWD ratio was 5:1, Amyotrophic lateral sclerosis (ALS) being the most frequent indication within NMD (78%). The main reason to initiate LTHNIV was diurnal hypercapnia (71%). Quality of life/sleep was the most important goal to achieve. In 25% of cases, clinicians based their choice of the ventilator on patients’ feedback. Among NIV-modes, pressure support ventilation spontaneous-timed (PSV-ST) was the most frequently prescribed for day and night-time. Mouthpieces were the preferred daytime NIV interface, whereas oro-nasal masks the first choice overnight. Heated humidification was frequently added to LTHNIV (72%). Single-limb circuits with intentional leaks (79%) were the most frequently prescribed. Follow-up was most often provided in an outpatient setting.ConclusionsThis ERS survey illustrates physicians’ practices of LTHNIV in RTD patients. NMD and, specifically, ALS were the main indications for LTHNIV. NIV was started mostly because of diurnal hypoventilation with a primary goal of patient-centred benefits. Bi-level PSV-ST and oro-nasal masks were more likely to be chosen for providing NIV. LTHNIV efficacy was assessed mainly in an outpatient setting.

Impact of frailty on periprocedural health care utilization in patients undergoing transcatheter edge-to-edge mitral valve repair

Background Frailty is a common characteristic of patients undergoing transcatheter mitral valve repair (TMVR). It is unclear whether the physical vulnerability of frail patients translates into increased procedural health care utilization. Methods and results Frailty was assessed using the Fried criteria in 229 patients undergoing TMVR using the MitraClip system at our institution and associations with total costs and costs by cost centers within the hospital incurred during periprocedural hospitalization were examined. Frail patients (n = 107, 47%) compared to non-frail patients showed significantly higher total costs [median/interquartile range, excluding implant costs: 7,337 € (5,911–9,814) vs 6,238 € (5,584–7,499), p = 0.001], with a difference in means of 2,317 €. Frailty was the only clinical baseline characteristic with significant association with total costs. Higher total costs in frail patients were attributable primarily to longer stay on intermediate/intensive care unit (3.8 ± 5.7 days in frail vs 2.1 ± 1.7 days in non-frail, p = 0.003), but also to costs of clinical chemistry and physiotherapy. The prolonged stay on intermediate/intensive care unit in frail patients was attributable to postprocedural complications such as bleeding, kidney injury, infections and cardiovascular instability. Conclusion Frailty is associated with a mean 32% increase of hospital costs in patients undergoing TMVR, which is primarily the result of a prolonged recovery and increased vulnerability to complications. These findings are valuable for a hospital’s total cost calculation and resource allocation planning. Since frailty is regarded a potentially reversible health state, preventive interventions may help reduce costs in frail patients. Graphic abstract