Disparities in Comfort Care Interventions Persist in Ischemic Stroke

An analysis in the Journal of the American Heart Association suggests that while the use of comfort care interventions in patients with ischemic stroke has increased overall in recent years, disparities in access to the treatments remain based on factors such as income level, race, and the location of the care center.

The researchers studied 10-year trends in the use of comfort care. Drawing on data from the National Inpatient Sample from 2006 to 2015, patients included in analysis had ischemic stroke with or without thrombolytic therapy and with comfort care interventions. There was a total of 4,249,201 ischemic encounters (3.8% had comfort care intervention use).

Over time, comfort care interventions were used more frequently overall regardless of acute treatment type. Disparities emerged, however, when looking at individual factors. Independent factors associated with receiving comfort care interventions included advanced age, female sex, white race, non-Medicare insurance, higher income, disease severity, comorbidity burden, and discharge from northeastern teaching hospitals. In the fully adjusted model, the authors reported that thrombolytic therapy and endovascular thrombectomy, respectively, y8ielded 6% and 10% greater likelihood of receiving comfort care interventions. There was a significant decline in in-hospital mortality vs. other dispositions over time, and comfort care interventions were linked with a 16% lower adjusted costs (despite length of hospital stay).

“Disparities in the prescribing of comfort care interventions among ischemic stroke patients was an important finding that needs to be carefully examined. To our knowledge such disparities have not been previously reported,” lead author Farhaan S. Vahidy, PhD, MBBS, MPH, FAHA, an associate professor of outcomes research and associate director of the Center for Outcomes Research at Houston Methodist, in Houston, said in a press release. “And, while more stroke patients are getting comfort care, overall use is still low, especially among people from underrepresented racial and ethnic groups.”

Read the study abstract here.