Abstract WP143: Towards What Goal? Palliative Care Utilization for the Post Endovascular Therapy Patient

Abstract

Introduction: AHA Guidelines call for utilization of Palliative Care (PC) for all patients with serious, life-threatening stroke. The purpose of this study was to assess factors associated with change in Code Status and PC utilization for patients with large vessel occlusion undergoing EVT. Methods: We retrospectively reviewed prospectively collected data in an IRB-approved stroke registry at two large, academic Comprehensive Stroke Centers. Subjects who received EVT for acute ischemic stroke (AIS) between 2014-2022 were included. Patients were grouped by change in code status during hospitalization. Baseline demographics were compared between groups with frequencies, chi-squared or t-test as appropriate. A correlation matrix was constructed and regression was performed. Results: Of the 411 included patients, 88 had code status changes. There was a significant difference in age, history of diabetes, last known well to hospital arrival, groin puncture to recanalization, and sICH within 36 hours between groups (Table 1). Goals of care (GOC) discussion was documented in only 36% of patients, with a mean of 4 days from stroke onset to code status change. Code status change was significantly associated with female sex (p=0.04), history of diabetes (p=0.01), sICH at 36 hours post rt-PA (p<0.001), PC consult (p<0.001), and rt-PA treatment (p=0.004). Code status change was best predicted with a model including age, DM, Initial NIHSS, and sICH within 36 hours. Conclusions: Despite undergoing acute intervention, few AIS patients had documented GOC discussions or code status change during hospitalization. Biases must be addressed in utilizing PC in AIS to provide comprehensive care. Standardized GOC discussions result in caregivers being more informed of prognosis and ensuring that patient’s GOC are honored. Further research is needed to determine barriers to GOC discussions and PC utilization in AIS.