Survival benefit of multidisciplinary care in amyotrophic lateral sclerosis in Spain: association with noninvasive mechanical ventilation
Autor/a
Paipa, Andres Julian
Povedano, Monica
Barcelo, Antonia
Domínguez, Raul
Saez, Marc
Turon, Joana
Prats, Enric
Farrero, Eva
Virgili, Nuria
Martínez, Juan Antonio
Corbella Virós, Xavier
Data de publicació
2019ISSN
1178-2390
Resum
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.
Tipus de document
Article
Versió del document
Versió acceptada
Llengua
English
Matèries (CDU)
61 - Medicina
Paraules clau
Estómac--Cirurgia
Respiració artificial
Assistència mèdica
Operacions quirúrgiques
Estómago--Cirugía
Estómago--Enfermedades
Estómac--Malalties
Respiración artificial
Asistencia médica
Operaciones quirúrgicas
Survival
Noninvasive Ventilation
Gastrostomy
Pàgines
6
Publicat per
Dove Press
Col·lecció
12
Publicat a
Journal of Multidisciplinary Healthcare
Aquest element apareix en la col·lecció o col·leccions següent(s)
- Ciències de la Salut [740]
Drets
© 2019 Paipa et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
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