Abstract TP351: Early Comfort Care Measures in Acute Stroke Patients: Analysis From the Get With the Guidelines Stroke Registry
Introduction: Mortality after stroke is often hastened by forgoing life-sustaining measures. We sought to determine the patient and hospital characteristics associated with early comfort measures only (CMO) after ischemic stroke (IS), intracranial hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in the Get With the Guidelines-Stroke registry.
Methods: We identified patients with IS, ICH, or SAH between November 5, 2009 and September 30, 2013 who: 1) had known early CMO status; 2) were not transferred in from or out to another acute care facility; and 3) from sites with > 10 patients during the study period. Using multivariable logistic regression, we assessed patient and hospital factors associated with early CMO use by stroke type. Early CMO was defined as occurring on hospitals day 1 or 2.
Results: Among 963,525 patients from 1,675 hospitals, 54,794 (5.6%) received early CMO (IS: 3.0%; ICH: 19.4%; SAH: 13.1%). There was a decrease in early CMO use (p<0.001) over the study period. In multivariable analysis, several patient (advancing age, female gender, non-white race-ethnicity), hospital (bed size and stroke case volume), and geographic factors (Midwest and West) were independently associated with early versus no early CMO use overall and by stroke type (Table).
Conclusions: Nationwide, early CMO is utilized in over 5% of stroke patients being more common in ICH and SAH than IS. Different patient and hospital characteristics influence CMO use among stroke types.
Author Disclosures: S. Prabhakaran: None. M. Cox: None. P.J. Schulte: None. Y. Xian: None. D. Zahuranec: None. E.E. Smith: None. M. Reeves: None. G.C. Fonarow: None. L.H. Schwamm: None.
- © 2016 by American Heart Association, Inc.