Survival benefit of multidisciplinary care in amyotrophic lateral sclerosis in Spain: association with noninvasive mechanical ventilation

Abstract

Andres Julian Paipa,1,* Monica Povedano,1,* Antonia Barcelo,2 Raul Domínguez,1 Marc Saez,2 Joana Turon,1 Enric Prats,1 Eva Farrero,1 Nuria Virgili,3 Juan Antonio Martínez,1 Xavier Corbella4,51Neurology Department, IDIBELL-Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; 2Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain; 3Endocrinology and Nutrition Department, IDIBELL-Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; 4Internal Medicine Department, IDIBELL-Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; 5Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain*These authors contributed equally to this work 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.Keywords: ALS, survival, multidisciplinary care, noninvasive mechanical ventilation, gastrostomy

Keywords

• ALS
• survival
• multidisciplinary care
• noninvasive mechanical ventilation
• gastrostomy.