Improvements in the multidisciplinary care are beneficial for survival in amyotrophic lateral sclerosis (ALS): experience from a tertiary ALS center.
Objective: The Ljubljana ALS Centre, established in 2002, is the only tertiary center for amyotrophic lateral sclerosis (ALS) in Slovenia. The aim of our study was to evaluate the impact of therapeutic interventions and improvements in the multidisciplinary care on the survival of our patients.Methods: All patients diagnosed with ALS at our center during years 2003-2005 (early group) and 2011-2012 (late group) were included in this retrospective cohort study (n = 124). Kaplan-Meier survival analysis and multiple regression analysis with Cox proportional hazards model were performed to compare survival and to evaluate the differences between the two cohorts.Results: Median survival from the time of diagnosis was 13.0 (95% CI 10.2-15.8) months in the early group and 21.8 (95% CI 17.2-26.4) months in the late group (p = 0.005). In the Cox proportional hazards analysis, the late group of patients was associated with better survival independently of all other prognostic factors (hazard ratio (HR)=0.51, 95% CI = 0.32-0.81, p = 0.004). Survival was also associated with patients' age, use of noninvasive ventilation (NIV) and gastrostomy. The model fit significantly improved when the interaction between the NIV use and the observed time period was added to the model (HR = 0.34, 95% CI = 0.12-0.96, p = 0.041).Conclusions: Our findings suggest that improvements in the multidisciplinary care were beneficial for survival of our patients with ALS. The survival benefit in the late group of our patients could be partially explained by the improvements in the NIV use at our center.
['Klavžar|Polona|P|0000-0001-6974-2115', 'Koritnik|Blaž|B|0000-0002-5083-8261', 'Leonardis|Lea|L|', 'Dolenc Grošelj|Leja|L|', 'Kirbiš|Mojca|M|0000-0003-1794-8829', 'Ristić Kovačič|Stanka|S|', 'Klinar|Polona|P|', 'Pohar Perme|Maja|M|0000-0002-3412-2642', 'Zidar|Janez|J|']
D000368:Aged D000690:Amyotrophic Lateral Sclerosis D015331:Cohort Studies D018691:Excitatory Amino Acid Antagonists D005260:Female D005774:Gastrostomy D006801:Humans D007400:Interprofessional Relations D008297:Male D008875:Middle Aged D010348:Patient Care Team D012121:Respiration, Artificial D019782:Riluzole D015996:Survival Rate D062606:Tertiary Care Centers
multidisciplinary care survival Amyotrophic lateral sclerosis noninvasive ventilation multidisciplinary approach