The benefit of multidisciplinary care in ALS

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive and complex neurodegenerative disease with a poor prognosis. It requires global care with an interdisciplinary approach that can improve the survival. Objective: To assess the benefit of multidisciplinary care in ALS patients in relation to survival and hospitalizations. Method: Longitudinal and retrospective study (2005-2016) of patients with ALS under pneumology follow-up compared to a cohort of patients (2016-2018) included in a single act multidisciplinary care model (ALS committee). It was recorded: age, sex, initial symptoms, presentation form, non-invasive ventilation (NIV) use, respiratory failure, hospitalizations and inclusion in ALS committee. Survival analysis of Kaplan-Meier and Cox multivariate regression was performed. Results: We included 176 patients, with 58,74±15,59 years, 55.7% male, 63.8% spinal form, and 83% sporadic presentation. Of them, were included 33 patients in the ALS committee, being younger than patients not included:51.18 years±15.93 vs 60.49 years±15.03 p=0.002, with no differences in relation to sex, type of ALS, onset of symptoms or NIV use. Patients included in committee had fewer hospitalizations:10 (30.3%)vs 80(56.7%)p=0.019 and shorter stays than patients not included:6.45±2,89 days vs 18.10±4,03 days p=0.010. Mean survival of patients included in committee was significantly longer than those not included:120,39±17,09 months vs 70.43±12.72 months p=0,000. Respiratory failure HR 1.876 95% 1.293-2.723 p=0.001, bulbar ALS HR 1.533 95% 1.051-2.236 p=0.027 and sporadic ALS HR 3.258 95% 1.747-6.075 p=0.000 are independent poor prognostic factors. Conclusions: A multidisciplinary aproach improve survival with fewer hospitalizations and shorter stay.