Epidemiology of Non-Invasive Domiciliary Ventilation in the southwest of Spain

Introduction: Epidemiology of home mechanical ventilation (HMV) and its changes is important to evaluate the situation of this therapy in a specific area. Methods: Prospective observational study to describe epidemiological changes of HMV in the health area of the University Hospital of Badajoz over three periods of time (A: Before 2008, B: Between 2008 and 2012 and C: From 2013 to the present). A comparative analysis was made between the three periods indicated. The patients were followed until June 2017. Results: We included 422 patients (53.1% women, mean age 65.8 ± 13.3 years). There was a significant increase in the number of patients since 2008 (A: 89, B: 163 and C: 170 patients) as well as in the age of onset of treatment (A: 18% > 75 vs. B: 26.4% and C: 33.5%, p = 0.027). The main diagnosis for the onset was obesity hypoventilation syndrome (55.1% vs 58.3% vs 57.6%). Presence of comorbidities and their number (> 3 comorbidities 41.6% vs 57.7% vs 64.1%, p = 0.002), presence of previous admissions and its number (1.7 ± 2.3 vs 1.6 ± 1.6 vs 2.4 ± 3.1, p = 0.005), increased with the time. We found changes in the situation at the beginning of HMV (Acute respiratory failure: 9% vs 20.9% vs 35%). We found a trend towards higher mortality among patients in the last period (Median survival A: 59 months [95% CI: 34.3-83.6] vs B: 54 months [95% CI: 37.1-70.8 ] vs C: 25 months [95% CI: 18.8-23.3], p = 0.13). Conclusions: We found a progressive increase in the number of patients who began HMV in our area. Changes in age, presence of comorbidities and previous situation at the beginning of the HMV show more "severe" patients in whom this procedure could have worse long-term results.