Abstract TP190: Elderly Stroke Patients Seen by Telemedicine and Retained at Spoke Community Hospitals Have Lower Early Mortality and Discharge to Hospice Than Those Presenting to a University Hub Hospital

Abstract

Introduction: Age remains one of the most important non-modifiable risk factors leading to poor outcomes after acute ischemic stroke (AIS). Telemedicine (TM) increases care access for elderly AIS patients especially in rural areas, yet their outcomes after initial TM consultation in the emergency department (ED) are unknown. We compared discharge disposition between elderly AIS patients who presented to and were retained at spoke community hospitals (SCHs) in our TM network versus those who presented directly to the TM hub (DTH). Methods: From both our network’s hub and TM stroke registries, we identified AIS patients ≥80 years old who presented to the ED (9/2015 - 12/2018). We compared incidence of discharge disposition to hospice or expiration (HE) as well as demographic and clinical characteristics between the SCH and DTH patients. Patients transferred after TM evaluation or who did not present directly to the hub ED were excluded. Results: Of 716 patients seen by TM, 532 were admitted to SCHs and 64 (12%) went on to HE. Out of 388 patients presenting DTH, 111 (29%) went on to HE. DTH patients were more likely to go on to HE (OR 2.93; 95% CI 2.08 - 4.12) compared to those presenting to and retained at SCHs (Figure 1a). This difference persisted when adjusting for baseline characteristics, stroke severity, and acute treatment (OR 3.01; 95% CI 1.01 - 8.96) (Figure 1b). In both study groups, increased age and severe stroke were highly associated with HE in the multivariate analysis. DTH patients with dementia had a higher odds of HE upon discharge (p=0.009) while those who received endovascular therapy had a lower odds (p=0.014). High premorbid mRS did not confer significantly higher odds of HE in either group. Conclusions: Elderly patients seen over TM and admitted to SCHs have lower early mortality and discharge disposition to hospice compared to those who present DTH. Further study is needed to elucidate whether disparities in palliative care utilization account for this difference.