PDF(Pubmed)
Abstract：
UNASSIGNED: Chronic obstructive pulmonary disease (COPD) is the most common indication for long-term domiciliary non-invasive ventilation (NIV) but there is uncertainty in data supporting current guidelines. This study described health trajectories before initiation of at-home NIV in people with COPD, and compared mortality outcomes between groups with different pre-NIV health trajectories.
UNASSIGNED: Data were from the French national health insurance reimbursement system database for individuals with COPD aged ≥40 years and ≥1 reimbursement for NIV between 1 January 2015 and 31 December 2019. Common health trajectories were determined using time sequence analysis through K-clustering (TAK analysis).
UNASSIGNED: Data from 54,545 individuals were analysed; the population was elderly (median age 70 years) with multiple comorbidities. Four clusters were generated. Cluster 1 (n = 35,975/54,545; 66%) had NIV initiated in ambulatory settings or after the first acute event/exacerbation. Cluster 2 (6653/54,545; 12%) started NIV after ≥2 severe exacerbations in the previous 6 months. Cluster 3 (11,375/54,545; 21%) started NIV after frequent severe COPD-related exacerbations in the previous year. Cluster 4 (652/54,545; 1%) started NIV after many long-lasting severe exacerbations. The four clusters differed in age, sex, comorbidities, pre-NIV investigations, and prescriber/location of NIV initiation. Mortality differed significantly between clusters: highest in Cluster 4 and lowest in Cluster 1.
UNASSIGNED: The significant heterogeneity in clinical initiation of NIV probably reflects the current lack of strong evidence and guideline recommendations. Knowledge about the characteristics and outcomes in different clusters should be used to address inequities and facilitate more consistent and personalised use domiciliary NIV in COPD.
UNASSIGNED: JLP and SB are supported by the French National Research Agency in the framework of the \"Investissements d\'avenir\" program (ANR-15-IDEX-02) and the \"e-health and integrated care and trajectories medicine and MIAI artificial intelligence (ANR-19-P3IA-0003)\" Chairs of excellence from the Grenoble Alpes University Foundation. This work was supported by ResMed.
UNASSIGNED: Data were from the French national health insurance reimbursement system database for individuals with COPD aged ≥40 years and ≥1 reimbursement for NIV between 1 January 2015 and 31 December 2019. Common health trajectories were determined using time sequence analysis through K-clustering (TAK analysis).
UNASSIGNED: Data from 54,545 individuals were analysed; the population was elderly (median age 70 years) with multiple comorbidities. Four clusters were generated. Cluster 1 (n = 35,975/54,545; 66%) had NIV initiated in ambulatory settings or after the first acute event/exacerbation. Cluster 2 (6653/54,545; 12%) started NIV after ≥2 severe exacerbations in the previous 6 months. Cluster 3 (11,375/54,545; 21%) started NIV after frequent severe COPD-related exacerbations in the previous year. Cluster 4 (652/54,545; 1%) started NIV after many long-lasting severe exacerbations. The four clusters differed in age, sex, comorbidities, pre-NIV investigations, and prescriber/location of NIV initiation. Mortality differed significantly between clusters: highest in Cluster 4 and lowest in Cluster 1.
UNASSIGNED: The significant heterogeneity in clinical initiation of NIV probably reflects the current lack of strong evidence and guideline recommendations. Knowledge about the characteristics and outcomes in different clusters should be used to address inequities and facilitate more consistent and personalised use domiciliary NIV in COPD.
UNASSIGNED: JLP and SB are supported by the French National Research Agency in the framework of the \"Investissements d\'avenir\" program (ANR-15-IDEX-02) and the \"e-health and integrated care and trajectories medicine and MIAI artificial intelligence (ANR-19-P3IA-0003)\" Chairs of excellence from the Grenoble Alpes University Foundation. This work was supported by ResMed.
摘要：
■慢性阻塞性肺疾病（COPD）是长期家庭无创通气（NIV）的最常见适应症，但支持当前指南的数据存在不确定性。这项研究描述了COPD患者在家庭NIV开始之前的健康轨迹，并比较了不同NIV前健康轨迹组的死亡率结局。
■数据来自法国国家健康保险报销系统数据库，用于2015年1月1日至2019年12月31日期间年龄≥40岁且NIV报销≥1的COPD患者。通过K聚类（TAK分析）使用时间序列分析确定常见的健康轨迹。
■分析了来自54,545个人的数据；该人群是老年人（中位年龄70岁），患有多种合并症。产生了四个簇。第1组（n=35,975/54,545;66％）在门诊或首次急性事件/恶化后开始NIV。第2组（6653/54,545;12％）在过去6个月中发生≥2次严重加重后开始NIV。第3组(11,375/54,545;21%)在前一年频繁的严重COPD相关恶化后开始NIV。第4组(652/54,545;1%)在多次长期严重加重后开始NIV。这四个集群的年龄不同，性别,合并症,NIV前的调查,和NIV开始的处方/位置。死亡率在集群之间存在显着差异：集群4中最高，集群1中最低。
■NIV临床启动的显著异质性可能反映了目前缺乏强有力的证据和指南建议。关于不同集群的特征和结果的知识应用于解决不平等问题，并促进COPD中更一致和个性化地使用domiciliaryNIV。
■JLP和SB在格勒诺布尔阿尔卑斯大学基金会的“调查”计划（ANR-15-IDEX-02）和“电子健康和综合护理与轨迹医学和MIAI人工智能（ANR-19-P3IA-0003）”卓越主席的框架内得到了法国国家研究机构的支持。这项工作得到了ResMed的支持。
■数据来自法国国家健康保险报销系统数据库，用于2015年1月1日至2019年12月31日期间年龄≥40岁且NIV报销≥1的COPD患者。通过K聚类（TAK分析）使用时间序列分析确定常见的健康轨迹。
■分析了来自54,545个人的数据；该人群是老年人（中位年龄70岁），患有多种合并症。产生了四个簇。第1组（n=35,975/54,545;66％）在门诊或首次急性事件/恶化后开始NIV。第2组（6653/54,545;12％）在过去6个月中发生≥2次严重加重后开始NIV。第3组(11,375/54,545;21%)在前一年频繁的严重COPD相关恶化后开始NIV。第4组(652/54,545;1%)在多次长期严重加重后开始NIV。这四个集群的年龄不同，性别,合并症,NIV前的调查,和NIV开始的处方/位置。死亡率在集群之间存在显着差异：集群4中最高，集群1中最低。
■NIV临床启动的显著异质性可能反映了目前缺乏强有力的证据和指南建议。关于不同集群的特征和结果的知识应用于解决不平等问题，并促进COPD中更一致和个性化地使用domiciliaryNIV。
■JLP和SB在格勒诺布尔阿尔卑斯大学基金会的“调查”计划（ANR-15-IDEX-02）和“电子健康和综合护理与轨迹医学和MIAI人工智能（ANR-19-P3IA-0003）”卓越主席的框架内得到了法国国家研究机构的支持。这项工作得到了ResMed的支持。
