Deans' stroke musings: Comfort Care on the Rise in Acute Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, April 9, 2021

Comfort Care on the Rise in Acute Stroke

Will you fucking blithering idiots actually work on solving stroke to 100% recovery? This patting yourself on the back way before you get to the goal line is totally outrageous. I bet you don't tell your patients you aren't even working on 100% recovery? WHAT EXCUSE ARE YOU USING?

Comfort Care on the Rise in Acute Stroke

Trends show steep drop in death in-hospital with palliative interventions

by Crystal Phend, Senior Editor, MedPage Today April 8, 2021

A smiling nurse greets her senior male patient

Palliative care and hospice for ischemic stoke patients has been rising over the past decade, with their outcomes improving nationally over time as well, researchers found.

Comfort care interventions for patients hospitalized with ischemic stroke rose 4.8-fold by 2014-2015 compared with 2006-2007, although the overall rate was still just 3.8% across that entire study period.

This significant increase was progressive, reported Farhaan Vahidy, PhD, MBBS, MPH, of the Houston Methodist Neurological Institute, and colleagues in the Journal of the American Heart Association. Adjusted odds compared with 2006-2007 were:

1.87 for 2008-2009
3.07 for 2010-2011
4.15 for 2012-2013
4.80 for 2014-2015

"Comfort care is becoming an increasingly important component of stroke care, and further studies are warranted to reduce disparities and optimize access, outcomes, and costs for those who need it," the researchers concluded.

That increase in use was despite increased acute care treatment options emerging during the study period. In fact, after full adjustment for other factors, patients receiving thrombolytic therapy and endovascular thrombectomy were 6% and 10%, respectively, more likely to get palliative or hospice care than those who didn't get those acute treatments.

The study included 4,249,201 adults with ischemic stroke in the National Inpatient Sample from 2006 to 2015. Among them, 3.8% had administrative data coded for comfort care intervention use.

While in-hospital mortality was about 15-fold more likely for comfort care recipients, in-hospital mortality dropped in this group over time relative to other discharge dispositions (aOR 0.46 over the 10-year period, 95% CI 0.38-0.56). Comfort care patients instead increasingly went to long-term care and home healthcare.

"The shifting trend in place of death indicates that while fewer patients with stroke are dying in the hospital (in-hospital mortality is decreasing because of improved acute treatment and management), there may still be a significant number of patients with stroke who die in the postacute, long-term care, or community setting following discharge," Vahidy's group wrote.

"This may be in line with the wishes and preferences of patients and their families, with the preferred setting for death being at home in the presence of loved ones," they added. "The provision of and access to postdischarge care options are essential to comfort care's impact on in-hospital outcomes as well as patient-centered goals of care."

Palliative and hospice interventions were linked with modestly longer hospital stays, but with a significant 16% lower cost for the hospitalization after adjustment for length of stay, death, age, and disease severity ($8,724 vs $10,405).

The researchers drew attention to "considerable sex, race, and geographic disparities" in comfort care use. Women were 56% more likely than men to get these interventions after adjustment for other factors; white patients were about 40% more likely than Black patients, and about 28% more likely than other racial and ethnic groups, to get comfort care.

Cultural preferences and practices could be at play, the researchers noted. However, they added, "Racism also plays a complex role in the risk factors that lead to poor outcomes as well as in the allocation of healthcare resources. Mechanisms of such disparities need to be further evaluated."

Palliative care is actually most common in New England hospitals, so the fact that hospitals in the West were 27% more likely to use these interventions than those in the Northeast "suggests a possible gap in the use of available comfort care services in Northeast hospitals for certain conditions such as stroke," Vahidy's group added.

Study limitations included lack of data on patients' baseline level of function and on advance directives, both important influences on comfort care use.