Comfort care interventions improve quality of life for patients with stroke
“Many stroke patients are candidates for comfort care, including palliative or hospice care, which can improve outcomes and quality of life. It is important that stroke patients who could benefit with better quality of life from comfort care have these options available,” Farhaan S. Vahidy, PhD, MBBS, MPH, FAHA, associate professor of outcomes research and the associate director of the Center for Outcomes Research at Houston Methodist, said in a press release.
Researchers analyzed 4,249,201 cases of ischemic stroke. Among the cohort, the mean age was 71 years and 3.8% had comfort care interventions.
In the analysis, advanced age, female sex, white race, non-Medicare insurance, higher income, disease severity, comorbidity burden and discharge from non-Northeastern teaching hospitals were associated with higher odds of receiving comfort care interventions, whereas comfort care interventions occurred less frequently among historically underrepresented racial and ethnic groups.
According to the researchers, regardless of treatment type, there was a spike in comfort care interventions use over time (adjusted OR = 4.8; 95% CI, 4.15-5.55).
Patients who received thrombolytic therapy with IV tissue plasminogen activator (tPA) and endovascular thrombectomy for stroke treatment had a better chance of receiving comfort care interventions (aOR for IV tPA = 1.06; 95% CI, 1.01-1.11; aOR for endovascular thrombectomy = 1.1; 95% CI, 1-1.21) compared with patients who did not receive those treatments.
Patients who had comfort care interventions had lower rates of in-hospital mortality compared with those who did not (aOR = 0.46; 95% CI, 0.38-0.56), but were more likely to receive long-term care or home health care, the researchers wrote.
The researchers also found that patients who had comfort care interventions had greater length of hospital stay than those who did not, but 16% lower costs.
“Disparities in the prescribing of comfort care interventions among ischemic stroke patients was an important finding that needs to be carefully examined. To our knowledge, such disparities have not been previously reported. And, while more stroke patients are getting comfort care, overall use is still low, especially among people from underrepresented racial and ethnic groups,” Vahidy said in the release.