Prevalence of HMV

In 1998, Pierson summarized earlier data on HMV from Great Britain, France, and the United States (10). At that time, the U.S. government estimated there to be 4000 ventilator-assisted individuals (VAIs) for a prevalence of 1.5/100,000 population. However, this figure likely underestimates the actual number by as much as 25%. In France, LTMV at home is received by 1500 to 2000 patients. In countries such as Denmark, Spain (Catalonia), Belgium, and Switzerland, only partial information is available. Germany has prescription guidelines, but Switzerland and France have closer control of the HMV population and France has a national registry of VAIs. 

The most complete European data on the use of HMV has been reported recently as the Eurovent study, a survey of long-term ventilator use conducted in 16 countries (15). In this survey, home ventilation was defined as ventilatory assistance for three months or more. Those receiving other forms of ventilation, such as rocking beds, negative-pressure ventilation, and phrenic nerve stimulation, were included. A total of 483 surveys were sent to the centers prescribing HMV in the 16 countries, with 329 centers (68%) responding. The numbers of patients and prevalence rates were estimated for each country. As noted in Table 3, there was a wide variation in the prevalence of HMV in Europe, ranging from 0.1/ 100,000 population in Poland to 17/100,000 in France. The survey identified a total of 21,526 VAIs and estimated the prevalence of HMV to be 6.6/100,000 population in Europe. 

Although the Eurovent investigators reported a close relationship between the prevalence of HMV and the length of time for which HMV services had been available (15), this did not explain the variation in prevalence in countries such as France, Denmark, and Sweden, all of which have HMV registries and observation systems in place. France 

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The sources of data on the prevalence of CRF are mostly indirect and not universally available in all countries and regions. Thus, an exact picture of CRF as a global issue remains largely incomplete, both in terms of geographical distribution and the global dimension. Multinational surveys, such as the Eurovent study, can provide insights into the use of HMV. 

Chronic health care in Europe, like the rest of the developed world, is characterized by an increasingly aging population often with complex medical problems, an increase in societal expectations, and an increase in the dependence on expensive technology. Chronic respiratory failure is no different and is expected to rise in prevalence because of the aging population and possibly because of increased tobacco use. The expansion in Europe (1-3) and the United States (4) over the last three decades in the use of home mechanical ventilation (HMV) mirrors this trend. HMV is used to treat chronic hypercapnic respiratory failure in both adults and children and is usually delivered non-invasively (NIV) with the majority of patients using only nocturnal or nocturnal plus part daytime NIV. NIV has been shown to reduce mortality and morbidity (5,6) and to improve quality of life (7). 

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