An exposed/unexposed cohort study assessing the effectiveness, the safety and the survival of patients established on home non-invasive ventilation after 80 years old

Background: Little is known about the use of long-term non-invasive ventilation (NIV) in the elderly. We aimed to assess if the effectiveness of long-term NIV of patients ≥ 80 years (older) was not greatly inferior to that of patients < 75 years (younger).

Methods: This retrospective exposed/unexposed cohort study included all patients established on long-term NIV treated at Rouen University Hospital between 2017 and 2019. Follow-up data were collected at the first visit following NIV initiation. The primary outcome was daytime PaCO2 with a non-inferiority margin of 50% of the improvement of PaCO2 for older patients compared to younger patients.

Results: We included 55 older patients and 88 younger patients. After adjustment on the baseline PaCO2, the mean daytime PaCO2 was reduced by 0.95 (95% CI: 0.67; 1.23) kPa in older patients compared to1.03 (95% CI: 0.81; 1.24) kPa in younger patients for a ratio of improvements estimated at 0.95/1.03 = 0.93 (95% CI: 0.59; 1.27, one-sided p = 0.007 for non-inferiority to 0.50). Median (interquartile range) daily use was 6 (4; 8.1) hours in older versus 7.3 (5; 8.4) hours in younger patients. No significant differences were seen in the quality of sleep and NIV safety. The 24-months survival was 63.6% in older and 87.2% in younger patients.

Conclusions: effectiveness and safety seemed acceptable in older patients, with a life expectancy long enough to expect a mid-term benefit, suggesting that initiation of long-term NIV should not be refused only based on age. Prospective studies are needed.