Palliative Care Consultation in Ischemic Stroke: Nationwide Disparities and Predictors
Muhammad Roshan Asghar1, Ali Al-Salahat1, Alexander Hall2, Saif Bawaneh3, Himanshu Verma1, Nasrin Rahimian1, Jagkirat Singh1, Rohan Sharma1
1Neurology, Creighton University, 2Creighton University, 3Mayo Clinic
Objective:
We aimed to examine demographic disparities and clinical predictors of palliative care consultation (PCC) in ischemic stroke hospitalizations in the United States (US) from 2016 to 2022.
Background:
Ischemic stroke is a leading cause of mortality and long-term disability in the US. PCC facilitates goals-of-care discussions, reduce non-beneficial interventions, and improve patient-centered outcomes. There is paucity of large scale data on disparities and predictors of PCC in ischemic stroke.
Design/Methods:
This was a retrospective study that utilized the National Inpatient Sample (NIS) database. Validated International Classification of Diseases (ICD) codes for ischemic stroke were used to identify hospitalizations. The primary outcome was receipt of PCC. Multivariable models were constructed to adjust for relevant characteristics.
Results:
There were an estimated 4,350,924 weighted hospitalizations, out of which 253,555 received PCC (58.7% were female). Black and Hispanic individuals were less likely to receive PCC than White individuals. Lower income quartiles, urban teaching facilities, Medicaid, and the South were all factors with lower odds of PCC receipt. Clinical variables predicting higher odds of PCC included cerebral edema, hemorrhage, higher NIH stroke scale, sepsis, and neoplastic conditions. Thrombolysis and thrombectomy carried lower odds of PCC receipt.
Conclusions:
This study uncovered sex- and race/ethnicity-based disparities relating to the use of PCC in ischemic stroke. Additionally, multiple clinical variables were found to be significantly associated with receipt of PCC in ischemic stroke. These data can be valuable to physicians, palliative care specialists, healthcare administrators and policymakers to address these disparities.
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