Impact of remote-monitored home non-invasive ventilation on patient outcomes: a retrospective cohort study

<bold>Introduction:</bold> We have routinely used remote monitoring and volume-assured assistive mode non-invasive ventilation (NIV) for patients with chronic hypercapnic respiratory failure since 2016. These technologies have supported service transformation including increased capacity, early hospital discharge, daycase therapy initiation and reduced frequency of face-face follow up. <bold>Methods:</bold> We undertook a retrospective cohort study using routine clinical data from electronic health records, to evaluate the clinical efficacy of this service model. <bold>Results:</bold> 362 patients with COPD (n=89), COPD-obstructive sleep apnoea (n=56) or obesity-related respiratory failure (217) initiated on home NIV between July 2016 and December 2020 were identified. 45% of patients were from most deprived population quintile, mirroring burden of disease. Initiation of remote-monitored NIV resulted in a global reduction in annual admission (0.4 per patient year) and occupied bed day (7.6 per patient year) rates in the following year. 274 patients continued NIV beyond year 1, which is comparable to other large, reported cohorts. Follow up blood gases confirmed control of respiratory failure. NIV non-users had reduced time to readmission (hazard ratio 2.11, p<0.001) and to death (HR 2.25, p<0.0001). 2-year survival outcomes stratified by primary diagnosis were comparable or improved vs published datasets. Adverse survival outcomes typically associated with deprivation were offset in the NIV user group. <bold>Conclusion:</bold> Adopting assistive technologies in service workflows is feasible and effective, relieving resource burdens, improving access, and offsetting inequalities for patients with chronic hypercapnic respiratory failure.