{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:30:12Z","timestamp":1792459812486,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"am","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Home mechanical ventilation (HMV) improves survival in Amyotrophic lateral sclerosis (ALS) and may be provided non-invasively (NIV) or invasively (IV). While NIV is guideline-recommended, the role of IV remains controversial, and data on long-term outcomes and NIV-to-IV transitions are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine survival across HMV strategies in people with ALS (pwALS) in Sweden over 27 years, factors associated with IV initiation, temporal trends in IV use and survival, and regional variation in IV utilisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A longitudinal cohort study of pwALS in the Swedish National Registry of Ventilatory Failure (Swedevox) 1996\u20132022, cross-linked with national registries. Factors associated with mortality and treatment patterns were assessed using multivariable regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1,360 pwALS, initial NIV was most common (92%), followed by IV (5%) and NIV-to-IV transitions (3%). Most IV initiations were non-elective (77% vs. 18% NIV, p\u2009&amp;lt;\u20090.001). NIV-to-IV transitions occurred mainly in metropolitan areas (OR 5.11; 95% CI 2.30\u201311.4). Median survival differed across observed treatment pathways (p\u2009&amp;lt;\u20090.001): 1.7 years with NIV, 4.9 years with IV, and 6.5 years with NIV-to-IV. Mortality was associated with higher age (aHR 1.33 per decade; 95% CI 1.26\u20131.41), female sex (aHR 1.15; 95% CI 1.02\u20131.29), and acute initiation (aHR 1.26; 95% CI 1.08\u20131.47). Longer time from diagnosis to NIV initiation was associated with reduced mortality risk (aHR 0.58 per year; 95% CI 0.55\u20130.62). Over time, patients initiated HMV at older age with better lung function and lower PaCO2 values among those with available measurements, whereas overall survival remained unchanged.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients receiving IV had longer observed survival, likely reflecting the benefits of a secured airway as well as patient selection and underlying disease trajectory. Most IV initiations were unplanned. Over three decades, HMV was initiated in older patients at an earlier stage of respiratory decline, but overall survival remained unchanged. IV use increased with marked regional variation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag219","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T01:50:23Z","timestamp":1784944223000},"source":"Crossref","is-referenced-by-count":1,"title":["Home mechanical ventilation for amyotrophic lateral sclerosis\u2013a national study of survival and treatment trends across 27 years"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0590-0417","authenticated-orcid":false,"given":"Andreas","family":"Palm","sequence":"first","affiliation":[{"name":"Respiratory, Allergy and Sleep Research, Uppsala University Department of Medical Sciences, , Box 256, SE-751 05, Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-5113","authenticated-orcid":false,"given":"Magnus","family":"Ekstr\u00f6m","sequence":"additional","affiliation":[{"name":"Lund University Department of Clinical Sciences, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine, , 221 84 Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2548-0236","authenticated-orcid":false,"given":"Jonas","family":"Einarsson","sequence":"additional","affiliation":[{"name":"Lund University Department of Clinical Sciences, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine, , 221 84 Lund,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3185-3316","authenticated-orcid":false,"given":"Karin","family":"Ersson","sequence":"additional","affiliation":[{"name":"Respiratory, Allergy and Sleep Research, Uppsala University Department of Medical Sciences, , Box 256, SE-751 05, Uppsala,","place":["Sweden"]},{"name":"Uppsala University Department of Medical Sciences, Clinical Physiology, , Uppsala,","place":["Sweden"]},{"name":"Uppsala University Department of Women\u2019s and Children\u2019s Health, Physiotherapy, , Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5327-7204","authenticated-orcid":false,"given":"Caroline","family":"Ingre","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Clinical Neuroscience, , Stockholm,","place":["Sweden"]},{"name":"Karolinska University Hospital Department of Neurology, , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5832-038X","authenticated-orcid":false,"given":"Ulf","family":"Kl\u00e4ppe","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Clinical Neuroscience, , Stockholm,","place":["Sweden"]},{"name":"Karolinska University Hospital Department of Neurology, , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-4510","authenticated-orcid":false,"given":"Eva","family":"Lindberg","sequence":"additional","affiliation":[{"name":"Respiratory, Allergy and Sleep Research, Uppsala University Department of Medical Sciences, , Box 256, SE-751 05, Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8486-6746","authenticated-orcid":false,"given":"Mirjam","family":"Ljunggren","sequence":"additional","affiliation":[{"name":"Respiratory, Allergy and Sleep Research, Uppsala University Department of Medical Sciences, , Box 256, SE-751 05, Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0091-924X","authenticated-orcid":false,"given":"Ingela","family":"Nygren","sequence":"additional","affiliation":[{"name":"Uppsala University Department of Neurology, Department of Medical Sciences, , Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1926-8464","authenticated-orcid":false,"given":"Josefin","family":"Sundh","sequence":"additional","affiliation":[{"name":"\u00d6rebro University Department of Respiratory Medicine, Faculty of Medicine and Health, , \u00d6rebro,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7405-1682","authenticated-orcid":false,"given":"Ludger","family":"Grote","sequence":"additional","affiliation":[{"name":"Sahlgrenska Academy Centre for Sleep and Wake Disorders, , , 413 90 Gothenburg,","place":["Sweden"]},{"name":"Gothenburg University Centre for Sleep and Wake Disorders, , , 413 90 Gothenburg,","place":["Sweden"]},{"name":"Sahlgrenska University Hospital Sleep Disorders Center, Department of Pulmonary Medicine, , Gothenburg,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,24]]},"container-title":["Annals of the American Thoracic 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