Decade‐Long Nationwide Trends and Disparities in Use of Comfort Care Interventions for Patients With Ischemic Stroke

Author:

Chu Kristie M.1ORCID,Jones Erica M.1ORCID,Meeks Jennifer R.2ORCID,Pan Alan P.2ORCID,Agarwal Kathryn L.3ORCID,Taffet George E.3,Vahidy Farhaan S.24ORCID

Affiliation:

1. Department of Neurology McGovern Medical School University of Texas Health Science Center at Houston TX

2. Center for Outcomes Research Houston Methodist Houston TX

3. Department of Geriatric Medicine Baylor College of Medicine Houston TX

4. The Houston Methodist Neurological Institute Houston Methodist Houston TX

Abstract

Background Stroke remains one of the leading causes of disability and death in the United States. We characterized 10‐year nationwide trends in use of comfort care interventions (CCIs) among patients with ischemic stroke, particularly pertaining to acute thrombolytic therapy with intravenous tissue‐type plasminogen activator and endovascular thrombectomy, and describe in‐hospital outcomes and costs. Methods and Results We analyzed the National Inpatient Sample from 2006 to 2015 and identified adult patients with ischemic stroke with or without thrombolytic therapy and CCIs using validated International Classification of Diseases, Ninth Revision ( ICD‐9 ) codes. We report adjusted odds ratios (ORs) and 95% CI of CCI usage across five 2‐year periods. Of 4 249 201 ischemic stroke encounters, 3.8% had CCI use. CCI use increased over time (adjusted OR, 4.80; 95% CI, 4.15–5.55) regardless of acute treatment type. Advanced age, female sex, White race, non‐Medicare insurance, higher income, disease severity, comorbidity burden, and discharge from non‐northeastern teaching hospitals were independently associated with receiving CCIs. In the fully adjusted model, thrombolytic therapy and endovascular thrombectomy, respectively, conferred a 6% and 10% greater likelihood of receiving CCIs. Among CCI users, there was a significant decline in in‐hospital mortality compared with all other dispositions over time (adjusted OR, 0.46; 95% CI, 0.38–0.56). Despite longer length of stay, CCI hospitalizations incurred 16% lower adjusted costs. Conclusions CCI use among patients with ischemic stroke has increased regardless of acute treatment type. Nonetheless, considerable disparities persist. Closing the disparities gap and optimizing access, outcomes, and costs for CCIs among patients with stroke are important avenues for further research.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

Reference39 articles.

1. Deaths: leading causes for 2017;Heron M;Natl Vital Stat Rep,2019

2. Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association

3. Predicting decline and survival in severe acute brain injury: the fourth trajectory;Creutzfeldt CJ;BMJ,2015

4. Palliative and End-of-Life Care in Stroke

5. What are palliative care and hospice care? National Institute on Aging. Available at: http://www.nia.nih.gov/health/what‐are‐palliative‐care‐and‐hospice‐care. Accessed January 19 2021.

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3