TY - JOUR
T1 - Survival and Healthcare Costs with Invasive Mechanical Ventilation versus Noninvasive Ventilation in Patients with Dementia Admitted with Pneumonia and Respiratory Failure
AU - Teno, Joan M.
AU - Sullivan, Donald R.
AU - Bunker, Jen
AU - Gozalo, Pedro
N1 - Funding Information:
Supported by National Institute on Aging grant R56AGO63748. The funder had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript. The content and views herein are those of the authors and do not reflect the official policy or position of the National Institutes of Health, the U.S. Department of Veterans Affairs, or the U.S. government. The Department of Veterans Affairs did not have a role in the conduct of the study; in the collection, management, analysis, and interpretation of data; or in the preparation of the manuscript.
Publisher Copyright:
Copyright © 2022 by the American Thoracic Society.
PY - 2022/8
Y1 - 2022/8
N2 - Rationale: Invasive mechanical ventilation (IMV) may be burdensome for persons with advanced dementia. Research has shown that IMV use in persons with dementia has increased in the United States, Spain, and Canada. Objectives: To compare the outcomes and healthcare costs among hospitalized patients with advanced dementia treated with noninvasive ventilation (NIV) versus IMV. Methods: A retrospective cohort study was conducted among hospitalized patients aged 66 years and older with pneumonia, or septicemia with pneumonia, treated with either NIV or IMV between 2015 and 2017. Persons were included if they had Minimum Data Set (MDS) assessments between 1 and 120 days before hospitalization indicating that they had advanced dementia with four or more impairments in activities of daily living. Propensity-matched analysis was performed using clinical information from the MDS, Chronic Condition Warehouse indicators of chronic disease, and prior use measures. Main outcome measures were survival and healthcare costs up to 1 year after discharge. Results: Among 27,483 hospitalizations between 2015 and 2017, IMV was used in 12.5% and NIV in 8.2%. A propensity-matched model comparing IMV versus NIV using clinical data from the MDS, Chronic Condition Warehouse indicators of chronic diseases, and prior use revealed matches for 96.3% of hospitalizations with the use of IMV. NIV matched cases had a higher 30-day mortality rate compared with IMV cases (58.7% vs. 51.9%, P < 0.001), but this survival benefit did not persist, as 1-year mortality was slightly higher among subjects with IMV compared with those with NIV (86.5% vs. 85.9%, P . 0.05). One-year healthcare costs after matching were higher among those treated with IMV compared with NIV (mean, $57,122 vs. $33,696; P, 0.001). Conclusions: Among patients with advanced dementia hospitalized with pneumonia or septicemia with pneumonia, improvement in 30-day survival for those treated with IMV compared with NIV must be weighed against lack of 1-year survival benefit and substantially higher costs.
AB - Rationale: Invasive mechanical ventilation (IMV) may be burdensome for persons with advanced dementia. Research has shown that IMV use in persons with dementia has increased in the United States, Spain, and Canada. Objectives: To compare the outcomes and healthcare costs among hospitalized patients with advanced dementia treated with noninvasive ventilation (NIV) versus IMV. Methods: A retrospective cohort study was conducted among hospitalized patients aged 66 years and older with pneumonia, or septicemia with pneumonia, treated with either NIV or IMV between 2015 and 2017. Persons were included if they had Minimum Data Set (MDS) assessments between 1 and 120 days before hospitalization indicating that they had advanced dementia with four or more impairments in activities of daily living. Propensity-matched analysis was performed using clinical information from the MDS, Chronic Condition Warehouse indicators of chronic disease, and prior use measures. Main outcome measures were survival and healthcare costs up to 1 year after discharge. Results: Among 27,483 hospitalizations between 2015 and 2017, IMV was used in 12.5% and NIV in 8.2%. A propensity-matched model comparing IMV versus NIV using clinical data from the MDS, Chronic Condition Warehouse indicators of chronic diseases, and prior use revealed matches for 96.3% of hospitalizations with the use of IMV. NIV matched cases had a higher 30-day mortality rate compared with IMV cases (58.7% vs. 51.9%, P < 0.001), but this survival benefit did not persist, as 1-year mortality was slightly higher among subjects with IMV compared with those with NIV (86.5% vs. 85.9%, P . 0.05). One-year healthcare costs after matching were higher among those treated with IMV compared with NIV (mean, $57,122 vs. $33,696; P, 0.001). Conclusions: Among patients with advanced dementia hospitalized with pneumonia or septicemia with pneumonia, improvement in 30-day survival for those treated with IMV compared with NIV must be weighed against lack of 1-year survival benefit and substantially higher costs.
KW - dementia
KW - mechanical ventilation
KW - noninvasive ventilation
KW - respiratory failure
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U2 - 10.1513/AnnalsATS.202110-1161OC
DO - 10.1513/AnnalsATS.202110-1161OC
M3 - Article
C2 - 35143372
AN - SCOPUS:85135420005
SN - 2325-6621
VL - 19
SP - 1364
EP - 1370
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 8
ER -