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Title: Survival benefit of multidisciplinary care in amyotrophic lateral sclerosis in Spain: association with noninvasive mechanical ventilation
Author: Paipa, Andres Julian
Povedano, Mònica
Barceló, Antonia
Domínguez, Raul
Saez, Marc
Turon, Joana
Prats, Enric
Farrero, Eva
Virgili, Núria
Martínez, Juan Antonio
Corbella, Xavier
Keywords: Esclerosi lateral amiotròfica
Artificial respiration
Respiració artificial
Amyotrophic lateral sclerosis
Issue Date: 1-Jan-2019
Publisher: Dove Medical Press Ltd
Abstract: Purpose: Multidisciplinary care has become the preferred model of care for patients with amyotrophic lateral sclerosis (ALS). It is assumed that the sum of interventions associated with this approach has a positive effect on survival. The objective of the study was to evaluate the impact of a multidisciplinary care approach on the survival of patients with ALS. Patients and methods: We performed a retrospective review of prospectively collected data in a tertiary referral center in Spain. Participants were patients with definite or probable ALS managed in a multidisciplinary care program. We compared demographic and survival data of patients with definite or probable ALS treated in a referral center without and with implementation of a multidisciplinary care program. We performed time-dependent multivariate survival analysis of the use of noninvasive mechanical ventilation (NIMV) and gastrostomy. Results: We evaluated 398 consecutive patients, of whom 54 were treated by a general neurologist and 344 were treated in the multidisciplinary care clinic. Patients receiving multidisciplinary care were older (62 vs 58 years), tended to have bulbar onset disease (30% vs 17.7%), and were more likely to receive riluzole (88.7% vs 29.6%, p<0.01), NIMV (48.8% vs 29.6%, p>0.001), and nutrition via gastrostomy (32.3% vs 3.7%, p<0.01). Kaplan-Meier analysis showed a 6-month increase in survival (log-rank, 16.03, p<0.001). Application of the Andersen-Gill model showed that the variables associated with reduced mortality were reduced time to NIMV and gastrostomy and the duration of both, thus reflecting compliance. Conclusions: Multidisciplinary care increased the survival of ALS patients in our study population. Timely use of respiratory support and gastrostomy are fundamental aspects of this benefit.
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It is part of: Journal Of Multidisciplinary Healthcare, 2019-01-01, Vol. 12, P. 465-470
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Appears in Collections:Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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