Abstract WP363: Trends and Disparities in Utilization of Palliative Care for Ischemic Stroke Patients Undergoing Thrombolytic Therapies: 10-Year Analysis of Nationwide Data

Abstract

Introduction: We characterize 10-year nationwide trends in utilization of palliative care (PC) for ischemic stroke (IS) patients and describe in-hospital outcomes and costs for IS patients receiving PC, particularly those with acute thrombolytic therapy (TT) i.e. IV tPA and endovascular thrombectomy (EVT). Methods: We analyzed the National Inpatient Sample (90% US hospitalizations) from 2006 - 2015 and identified adult (age ≥18) IS patients, with or without TT and PC using validated ICD-9 codes. We used survey design methods to report nationally representative adjusted odds ratios (aOR) of PC utilization across five 2-year time periods. Results: Of 4,249,201 IS encounters, 4% were coded for PC utilization. PC utilization increased over time (aOR 4.80, 95% CI 4.15 - 5.55), regardless of acute treatment type (Figure 1a). Advanced age, female sex, White race, non-Medicare insurance, higher income, disease severity and comorbidity burden, and discharge from teaching hospitals in non-Northeastern regions were independently associated with receiving PC. In the fully adjusted model, treatment with IV tPA and EVT respectively confer a 5% and 10% greater likelihood of receiving PC. Overall, PC utilization is associated with higher mortality (aOR 15.14, 95% CI 14.36 - 15.96). However, 10-year outcome trends demonstrate a significant decline in in-hospital mortality compared to all other dispositions (aOR 0.46, 95% CI 0.38 - 0.56) with an increasing proportion of PC patients receiving long-term care and home health/hospice (aOR 2.42, 95% CI 2.03 - 2.88) (Figure 1b). Despite longer length of stay, PC hospitalizations incurred 16% lower adjusted costs. Conclusions: Though PC utilization has increased in IS patients, considerable disparities exist. Acute TT is associated with higher PC utilization and outcome trends indicate lower in-hospital mortality with higher long-term care and home health/hospice. Protocolized PC for IS patients may optimize outcomes and costs.