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Comfort Care Intervention Use for Ischemic Stroke Increased Over Time

CCI use still low but associated with significant decline in in-hospital mortality over time

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WEDNESDAY, April 7, 2021 (HealthDay News) -- Among patients with ischemic stroke, comfort care intervention (CCI) use has increased over time, but there are considerable disparities in use, according to a study published online April 7 in the Journal of the American Heart Association.

Kristie M. Chu, M.D., from McGovern Medical School University of Texas Health Science Center at Houston, and colleagues identified adult patients with ischemic stroke with or without thrombolytic therapy and CCIs from the National Inpatient Sample 2006 to 2015. Adjusted odds ratios and 95 percent confidence intervals of CCI usage were reported across five two-year periods.

The researchers found that 3.8 percent of 4,249,201 ischemic stroke encounters involved CCI use. Regardless of acute treatment type, there was an increase in CCI usage over time (adjusted odds ratio, 4.80). Independent associations with receiving CCIs were seen for advanced age, female sex, White race, non-Medicare insurance, higher income, disease severity, comorbidity burden, and discharge from non-Northeastern teaching hospitals. Thrombolytic therapy and endovascular thrombectomy conferred a 6 and 10 percent greater likelihood, respectively, of receiving CCIs in the fully adjusted model. Compared with all other dispositions, a significant decline was seen in in-hospital mortality over time among CCI users (adjusted odds ratio, 0.46). CCI hospitalizations incurred 16 percent lower adjusted costs despite longer length of stay.

"While more stroke patients are getting comfort care, overall use is still low, especially among people from underrepresented racial and ethnic groups," a coauthor said in a statement.

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