Nabeel Chauhan1, Syed F Ali2, Yousef Hannawi3, Archana Hinduja3. 1. 1 Department of Neurology, University of Utah, Salt Lake City, UT, USA. 2. 2 Department of Neurology, University of Arkansas or Medical Sciences, Little Rock, AR, USA. 3. 3 Division of Cerebrovascular and Neurocritical Care, Department of Neurology, Ohio State University, Columbus, OH, USA.
Abstract
BACKGROUND: : A significant percentage of terminally ill patients are discharged to hospice care following a devastating stroke. OBJECTIVE: : We sought to determine the factors associated with hospital discharge to hospice care in a large cohort of patients with stroke. METHODS: : Using the institutional Get With The Guidelines-Stroke database, all consecutive patients with acute ischemic stroke (AIS) who were alive at discharge, from January 2009 until July 2015, were analyzed. Univariate and multivariable statistical analyses were performed to determine the factors associated with discharge to hospice care. RESULTS: : Of 2446 patients with AIS, 3.4% died and were excluded of remaining 2363 patients, and 4.2% were discharged to hospice care. Univariate analysis identified patients who were discharged to hospice care to be older, caucasian, Medicare or private insurance, have atrial fibrillation, heart failure and less often had diabetes mellitus or smoked. Altered mentation at presentation and urinary tract infection were more common in patients discharged to hospice. On multivariable analysis, patients transferred to hospice care were older (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01-1.07; P < .001), had a high National Institute of Health Stroke Scale (NIHSS; OR: 1.15, 95% CI: 1.10-1.20; P < .001), and altered mental status at presentation (OR: 2.42, 95% CI: 1.29-4.55; P < .001). CONCLUSION: : In our study, elderly patients with high NIHSS and altered mental status were identified as factors associated with transition to hospice care following AIS. Prospective studies on the optimal timing of initiation of these consults are needed.
BACKGROUND: : A significant percentage of terminally ill patients are discharged to hospice care following a devastating stroke. OBJECTIVE: : We sought to determine the factors associated with hospital discharge to hospice care in a large cohort of patients with stroke. METHODS: : Using the institutional Get With The Guidelines-Stroke database, all consecutive patients with acute ischemic stroke (AIS) who were alive at discharge, from January 2009 until July 2015, were analyzed. Univariate and multivariable statistical analyses were performed to determine the factors associated with discharge to hospice care. RESULTS: : Of 2446 patients with AIS, 3.4% died and were excluded of remaining 2363 patients, and 4.2% were discharged to hospice care. Univariate analysis identified patients who were discharged to hospice care to be older, caucasian, Medicare or private insurance, have atrial fibrillation, heart failure and less often had diabetes mellitus or smoked. Altered mentation at presentation and urinary tract infection were more common in patients discharged to hospice. On multivariable analysis, patients transferred to hospice care were older (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01-1.07; P < .001), had a high National Institute of Health Stroke Scale (NIHSS; OR: 1.15, 95% CI: 1.10-1.20; P < .001), and altered mental status at presentation (OR: 2.42, 95% CI: 1.29-4.55; P < .001). CONCLUSION: : In our study, elderly patients with high NIHSS and altered mental status were identified as factors associated with transition to hospice care following AIS. Prospective studies on the optimal timing of initiation of these consults are needed.
Entities:
Keywords:
Get With The Guidelines; altered mental status; elderly; hospice care; stroke; utilization
Authors: Young-Taek Park; Daekyun Kim; Su-Jin Koh; Yeon Sook Kim; Sang Mi Kim Journal: Int J Environ Res Public Health Date: 2022-01-29 Impact factor: 3.390