The HOT-HMV Trial:
Key takeaways and steps for setting a new standard of care
While home oxygen therapy offers significant benefits to patients with COPD, new data show that an additional intervention can multiply the gains. We’ll show you what you need to know and how you can help redefine quality care in your practice.
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NIV usage: then and now
Noninvasive ventilation (NIV) was originally used to treat neuromuscular disease. But new evidence now strongly supports the use of NIV to treat patients with advanced COPD.1 Recently, NIV usage has increased in hospitals to treat COPD exacerbations, which can be difficult for the patient, and costly to healthcare systems worldwide.2,3 But, when patients are discharged, they are often armed only with oxygen, medication, and an inhaler. While these measures can suffice for some patients, others require more to keep them healthy at home. This is where the addition of home mechanical ventilation or non-invasive ventilation comes into play. A new study supported by funding and product by Philips Respironics and ResMed found unprecedented benefits in using home oxygen therapy (HOT) in addition to home mechanical ventilation (HMV) in patients with COPD and chronic hypercapnia.4 Let’s take a closer look at the study and what it means for your practice.
Proven benefits you can’t ignore
Increasing time between readmission with HOT HMV
Patient population:
- 59 patients received HOT
- 57 patients received HOT and HMV
Randomized treatment:
- General COPD education
- Treatment guidelines
- Device usage
Patient education was supplied in the following areas:
- General COPD education
- Treatment guidelines
- Device usage
Follow-up:
Patients were seen for follow up visits:
- 6 weeks
- 3 months
- 6 months
- 12 months
Results:
Median admission-free survival:
- HOT HMV: 4.3 months
- HOT: 1.4 months
Conclusion:
In patients with persistent hypercapnia, following an acute exacerbation of COPD, the addition of home NIV to home O2 therapy prolonged the time to readmission or death within 12 months by 50%.
The data from the HOT HMV trial provides
hope to patients who previously had no other options.”
–Dr. Nicholas Hart, St. Thomas’ Hospital
What role can you play in implementing this new approach?
We’ll show you how to lead your institution into the future of care for advanced-stage COPD patients.
Here are the 4 key steps:
Identify COPD patients who are best candidates to receive NIV at home following an acute exacerbation requiring hospitalization.
See patients in clinic for a follow-up two to four weeks after discharge.
Assess arterial blood gas measurements.
If PaCO2 >7 kPa or if there is >53 mmHg begin treatment with HOT HMV.
Improved quality of care—but at what cost?
The use of HOT HMV can put your institution on the cutting edge of care delivery and performance, in ways such as4:
Reducing the frequency of exacerbations
Reducing readmissions and associated costs and penalties
Keeping patients self-managing in the comfort of their home
Improving patients’ quality of life
Raising the standard of care starts with you
Today, nearly one in four patients will be readmitted following an acute exacerbation.6 Not only does this affect patients’ quality of life, but multiplies costs and penalties throughout health systems. With the proven benefits of the HOT HMV study, patients and clinicians now have hope for better outcomes. This additional avenue of intervention has the potential to change how COPD patients are treated worldwide. But don’t let the benefits pass you by. Begin exploring this new intervention today and help create unprecedented benefit for healthcare systems, and the patients you serve.
Further reading
References: 1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2017 Report. http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/. Accessed June 1, 2017. 2. Chevrolet JC, Jolliet P, Abajo B, Toussi A, Louis M. Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses. Chest. 1991;100(3):775-782. 3. Nava S, Evangelisti I, Rampulla C, Compagnoni ML, Fracchia C, Rubini F. Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure. Chest. 1997;111(6):1631-1638. 4. Murphy PB, Rehal S, Arbane G, Bourke S, Calverley PMA, Crook AM, Dowson L, Duffy N, Gibson GJ, Hughes PD, Hurst JR, Lewis KE, Mukherjee R, Nickol A, Oscroft N, Patout M, Pepperell J, Smith I, Stradling JR, Wedzicha JA, Polkey MI, Elliott MW, Hart N. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation A Randomized Clinical Trial. JAMA. Published online May 21, 2017. doi:10.1001/jama.2017.4451. 5. Gunning KE. Pathophysiology of respiratory failure and indications for respiratory support. Surgery (Oxford). 2003;21:72-76. 6. National Quality Measures Clearinghouse (NQMC). Measure summary: Chronic obstructive pulmonary disease (COPD): hospital 30-day, all-cause, risk-standardized readmission rate following acute exacerbation of COPD hospitalization. National Quality Measures Clearinghouse (NQMC) Web site. https://www.qualitymeasures.ahrq.gov/summaries/summary/49195/chronic-obstructive-pulmonary-disease-copd-hospital-30day-allcause-riskstandardized-readmission-rate-following-acute-exacerbation-of-copd-hospitalization. Published October 1, 2015. Accessed June 1, 2017.