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Can Telemonitoring Predict Patient-Reported Leak Perception in Long-Term Home Noninvasive Ventilation for Patients
Messaoud Lefouili1, Dany Jaffuel2, Sandra Journet3
1HP2 laboratory, INSERM U1300, University Grenoble Alpes, Grenoble, France; AGIR à dom Homecare Charity, Meylan, France.
Background:
Home noninvasive ventilation (NIV) improves outcomes in patients with chronic respiratory failure; however, telemonitoring remains challenging due to undefined appropriate alert thresholds. Current leak thresholds lack clinical validation, potentially leading to inefficient care delivery and alert fatigue among health care providers.
Research Question:
Can telemonitoring leak data predict patient-reported perceptions of leaks in home NIV for patients with chronic respiratory failure?
Study Design And Methods:
Data collected between March 2019 and May 2023 from 571 patients with chronic respiratory failure receiving home NIV were analyzed retrospectively. Inclusion required at least 1 S3-NIV questionnaire and 28 days of preceding telemonitoring leak data. Twenty-seven leak features were extracted across 7-, 14-, 21-, and 28-day windows. Statistical analysis included analyses of variance, effect size calculation (eta squared; η2), and comparison of predictive performance using linear mixed-effects regression and K-nearest neighbors algorithms.
Results:
Only S3-NIV item 8 ("I am disturbed by leaks") showed significant associations with leak features. Whereas no demographic or NIV setting differences were found between patients reporting leak disturbances and those who did not, disturbed patients consistently reported more NIV-related issues and respiratory symptoms. Leak features reflecting central tendency and magnitude showed the highest effect sizes (η2 = 0.021-0.075). However, predictive models demonstrated limited ability to accurately predict patient-perceived leaks.
Interpretation:
Telemonitoring leak data alone have limitations in predicting patient perception of leaks, suggesting that individual factors beyond objective measurements play a significant role. A proactive patient-centered management approach integrating telemonitoring data and patient-reported outcomes is thus needed.
Clinical Trial Registration:
Registered on Health Data Hub; No. 23517022; URL: www.health-data-hub.fr.
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