At-home NIV initiation with telemonitoring in ALS patients: a retrospective study

Noninvasive ventilation (NIV) improves survival and quality of life in amyotrophic lateral sclerosis (ALS) patients. NIV initiation is mostly conducted at hospital, but a recurrent lack of hospital beds led to the necessity to explore an at-home initiation process. We report here data from our NIV initiation cohort in ALS patients.Could, our at-home NIV initiation process with telemonitoring in ALS patients, be an efficient solution for adherence and nocturnal hypoxemia correction?We performed a retrospective analysis of data collected from the 265 ALS patients followed in the Bordeaux ALS Centre for whom NIV initiation has been carried out between September 2017 and June 2021 with two modalities: at-home initiation or in-hospital initiation. The primary outcome was adherence to NIV at 30 days. The secondary outcome was at-home NIV initiation process efficiency on nocturnal hypoxemia correction.At 30 days, NIV adherence (mean >4 h·day−1) was 66% in total population, 70% in the subgroup at-home NIV initiation and 52% in the subgroup in-hospital NIV initiation. Nocturnal hypoxemia correction was observed in 79% of adherent patients in the subgroup at-home NIV initiation. Mean delay of NIV prescription and at-home NIV initiation was 8.7 days (+/- 6.5)versus29,5% at hospital.Our study shows that our at-home NIV initiation process in ALS patients is a good option to provide rapid access to NIV with good adherence and efficiency. Further literature on at-home NIV initiation benefit is welcomed especially to evaluate long-term efficiency and global cost analysis.