Introduction: Hospice is an option in providing terminally ill patients with good quality end of life care. We sought to determine demographic and clinical factors associated with discharge to hospice in acute ischemic stroke (AIS) patients.
Methods: Using our institutional GWTG database, we analyzed 2,363 consecutive AIS patients who were alive at the time of discharge, from Jan 2009 till July 2015. Univariate and multivariable analysis was performed to determine factors associated with discharge to hospice.
Results: Out of 2,363 AIS patients, 100 (4.2%) were discharged to hospice care. Patients discharged to hospice care were more likely to be older, Caucasian and less likely to be African American. They more often had Medicare or private insurance, while less likely paid for the care themselves. Patients discharged to hospice more often had atrial fibrillation and heart failure, while less often had diabetes mellitus or were smoker. Altered level of consciousness at presentation was more often in patients discharged to hospice. Although the rates of thrombolysis and pneumonia were similar, UTI was more common in patients discharged to hospice. Thirty-seven percent of patients were made comfort measure prior to discharging them to hospice (Table). On multivariable analysis, older age [OR 1.04 (95% CI 1.01 - 1.07); p<0.001], higher NIHSS [OR 1.15 (95% CI 1.10 - 1.20); p<0.001] and altered level of consciousness at presentation [OR 2.42 (95% CI 1.29 - 4.55); p<0.001] were significantly associated with discharge to hospice care.
Conclusion: The rates of discharge to hospice following AIS have substantially grown in the past decade and at our institution 4.2% were discharged to hospice. These patients were older, had higher median NIHSS and more often had altered level of consciousness upon presentation. Large, multicenter studies are needed to address the variation in the rates of hospice care across the United States.