Paipa, Andres JulianPovedano, MònicaBarceló, AntoniaDomínguez, RaúlSaez, MarcTuron, JoanaPrats, EnricFarrero, EvaVirgili, NúriaMartínez, Juan AntonioCorbella, Xavier2020-11-022020-11-022019-01-01https://hdl.handle.net/2445/171632Purpose: 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.6 p.application/pdfengcc by-nc (c) Paipa, Andres Julian et al., 2019http://creativecommons.org/licenses/by-nc/3.0/es/Esclerosi lateral amiotròficaArtificial respirationRespiració artificialAmyotrophic lateral sclerosisinfo:eu-repo/semantics/article2020-10-26info:eu-repo/semantics/openAccess31354285