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Abstract: TH-PO784

Outcomes of Palliative Care Consultation in Patients With CKD Hospitalized With Acute Stroke

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Jawed, Areeba, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Saeed, Fahad, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
  • Slaven, James, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Comer, Amber, Indiana University School of Medicine, Indianapolis, Indiana, United States
Background

There is a heightened mortality risk for patients with Chronic Kidney Disease (CKD) hospitalized with acute stroke. Both American Heart Association and American Stroke Association endorse involvement of palliative care in these patients.

Methods

We report a secondary analysis of a retrospective observational study performed in adult patients with CKD discharged with a diagnosis of acute ischemic stroke from four large, urban hospitals in the mid-west between January 2016 to December 2018. We obtained data on demographics, co-morbid conditions, code status on admission and discharge, involvement of ethics and spiritual care and palliative care services. We compared outcomes between acute stroke patients with CKD who received a palliative care consultation versus those who did not. Outcome measures included:in-hospital mortality, mechanical ventilation, tracheostomy, artificial Nutrition/gastrostomy tube, thrombolytic therapy (tPA) , thrombectomy, ICU Admission, dialysis, cardiopulmonary resuscitation, and end-of-life quality measures including completion of advanced care directives and documentation of goals of care conversations.

Results

Among the 1480 patients (mean age = 73.1±14.4, 57.3% female, and 75.2% white) admitted with acute stroke, 206 had CKD stages 3-5D, and 26.2% (n=54) were seen by palliative care. Those who received palliative care consultation were older (mean age 81.1 vs. 70.2, p<0.0001), had do-not-resuscitate code status at discharge (77.8% vs. 24.3%, OR=10.88 (5.19, 22.82) p<.0001), and were more likely to receive spiritual care (81.5% vs. 57.9%, OR=3.20 (1.50, 6.83), p<0.0001). A higher proportion of patients seen by palliative care died during the same hospitalization (32.1% vs. 10.6%, OR=3.98 (1.84, 8.65), p=.0003), enrolled in hospice (24.5% vs. 4.0%, OR=7.91 (2.83, 22.11), p<.0001), transitioned to comfort care (51.9% vs. 11.9%, OR=7.96 (3.85, 16.45), p<.0001), discontinued artificial nutrition (25.9% vs. 4.6%, OR=7.20 (2.72, 19.04, p <0.0001, and had vent withdrawn: 16.7% vs. 6.6%, OR=2.82 (1.08, 7.37); p=.0289 at discharge.

Conclusion

Palliative Care consultation is associated with improved end of life quality outcomes and an increase in hospice enrollment in patients with acute stroke and CKD.