Palliative and End-of-Life Care in Stroke

Holloway, Robert G.; Arnold, Robert M.; Creutzfeldt, Claire J.; Lewis, Eldrin F.; Lutz, Barbara; McCann, Robert M.; Rabinstein, Alejandro A.; Saposnik, Gustavo; Sheth, Kevin N; Zahuranec, Darin B.; Zipfel, Gregory J.; Zorowitz, Richard D.

doi:10.1161/str.0000000000000015

Cited by 243 publications

(135 citation statements)

References 287 publications

(286 reference statements)

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“…Similar to findings from other smaller studies, 6 this suggests a mismatch between practice reality and stroke guidelines, which recommend time-limited trials of nasogastric feeding for a period of ≤2 to 3 weeks prior to placing a surgical feeding tube. 7 We found that age was the greatest determinant of early PEG tube placement. In fact, the oldest PEG tube recipients (≥85 years) had 1.7× the adjusted odds of receiving an early PEG compared with the youngest (18-54 years), and there were no differences in discharge disposition for those receiving their PEG early versus later in this subset of older patients.…”

Section: Discussionmentioning

confidence: 72%

Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke

George

Kelly

Albert

et al. 2017

Stroke

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Background and Purpose-Stroke guidelines recommend time-limited trials of nasogastric feeding prior to percutaneous endoscopic gastrostomy (PEG) tube placement. We sought to describe timing of PEG placement and identify factors associated with early PEG for acute ischemic stroke. Methods-We designed a retrospective observational study to examine time to PEG for ischemic stroke admissions in the Nationwide Inpatient Sample, 2001 to 2011. We defined early PEG placement as 1 to 7 days from admission. Using multivariable regression analysis, we identified the effects of patient and hospital characteristics on PEG timing. Results-We identified 34 623 admissions receiving a PEG from 2001 to 2011, 53% of which received the PEG 1 to 7 days from admission. Among hospitals placing ≥10 PEG tubes, median time to PEG for individual hospitals ranged from 3 days to over 3 weeks (interquartile range 6-8.5 days). Older adult age groups were associated with early PEG (≥85 years versus 18-54 years: adjusted odds ratio 1.68, 95% confidence interval 1.50-1.87). Those receiving a PEG and tracheostomy were more likely to receive the PEG beyond 7 days, and these patients were more often younger compared with PEG only recipients. Those admitted to high-volume hospitals were more likely to receive their PEG early (≥350 versus <150 hospitalizations; adjusted odds ratio 1.26, 95% confidence interval 1.17-1.35). Conclusions-More than half of the PEG recipients received their surgical feeding tube within 7 days of admission. The oldest old, who may benefit most from time-limited trials of nasogastric feeding for ≥2 to 3 weeks, were most likely to receive a PEG within 7 days.

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Section: Discussionmentioning

confidence: 72%

Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke

George

Kelly

Albert

et al. 2017

Stroke

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“…It remains unclear however, whether the higher mortality rate and more frequent use of comfort measure in whites are reflective of patient/family preferences, treatment futility, or failure to provide appropriate care to patients who still have the possibility of favorable outcomes. 35 Therefore, if mortality is to be one of the metrics to quantify ICH care quality, great caution should be undertaken in interpreting these results.…”

Section: November 2014mentioning

confidence: 99%

Racial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage

Xian

Holloway

Smith

et al. 2014

Stroke

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Background and Purpose— Although racial/ethnic differences in care are pervasive in many areas of medicine, little is known whether intracerebral hemorrhage (ICH) care processes or outcomes differ by race/ethnicity. Methods— We analyzed 123 623 patients with ICH (83 216 white, 22 147 black, 10 519 Hispanic, and 7741 Asian) hospitalized at 1199 Get With The Guidelines-Stroke hospitals between 2003 and 2012. Multivariable logistic regression with generalized estimating equation was used to evaluate the association among race, stroke performance measures, and in-hospital outcomes. Results— Relative to white patients, black, Hispanic, and Asian patients were significantly younger, but more frequently had more severe stroke (median National Institutes of Health Stroke Scale, 9, 10, 10, and 11, respectively; P <0.001). After adjustment for both patient and hospital-level characteristics, black patients were more likely to receive deep venous thrombosis prophylaxis, rehabilitation assessment, dysphagia screening, and stroke education, but less likely to have door to computed tomographic time ≤25 minutes and smoking cessation counseling than whites. Both Hispanic and Asian patients had higher odds of dysphagia screening but lower odds of smoking cessation counseling. In-hospital all-cause mortality was lower for blacks (23.0%), Hispanics (22.8%), and Asians (25.3%) than for white patients (27.6%). After risk adjustment, all minority groups had lower odds of death, of receiving comfort measures only or of being discharged to hospice. In contrast, they were more likely to exceed the median length of stay when compared with white patients. Conclusions— Although individual quality indicators in ICH varied by race/ethnicity, black, Hispanic, and Asian patients with ICH had lower risk-adjusted in-hospital mortality than white patients with ICH.

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“…The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with CVD and stroke and their families and to make recommendations for policy decisions (Appendix 1). Two recent scientific statements by the AHA/ASA, "Palliative and End-of-Life Care in Stroke" 1 and "Decision Making in Advanced Heart Failure," 2 informed the writing of this policy statement.…”

Section: Introductionmentioning

confidence: 99%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

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AbstrAct:The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidencebased care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient-and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payerprovider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

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Palliative and End-of-Life Care in Stroke

Cited by 243 publications

References 287 publications

Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke

Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke

Racial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

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