Racial Differences In Palliative Care Utilization AndImpact On Inpatient MortalityLengthStay And Costs Among Patients With Ischemic Stroke

Background and Purpose: Palliative is increasingly used in critically ill patients which has lead to shorter length of stays, higher inpatient mortality and lower utilization of aggressive treatment. We performed analysis to evaluate trends in utilization of palliative care among patients with Ischemic Stroke and its effect on in-hospital outcomes over a 10-year period. Methods: We obtained data for patients admitted to hospitals in the United States from 2009 to 2018 with a primary diagnosis of Ischemic stroke (IS) using a large national database. We determined the overall and among different races, rate of utilization of palliative care in patients with IS and associated in-hospital outcomes consisting of mean hospital charges, mean length of stay and in-hospital mortality. Results: Out of 5525248 patients admitted with primary diagnosis of IS, palliative care was used in 150301 (2.72%). There was a 1.05-fold utilization of PC (1.69% in 2009 vs 1.78% in 2018; p<0.001) from 2009 till 2018. Similarly, there were 1.003, 1.4, 1.04 and 1.05-folds increase in utilization of PC among different races: whites, blacks, hispanics and others respectively, p<0.001. Overall rates of PC utilization among different races: whites, blacks, hispanics and others were: 3.0%, 1.6%, 2.03% and 2.69%, p<0.001 respectively. The length of hospitalization remained significantly higher (6.0±7.4 versus 3.8±5.2, p<0.001) in patients undergoing PC compared those who did not. The cost of hospitalization remained significantly higher ($55068 ± 84630 versus $ 40148 ± 53479, p<0.001) in patients undergoing PC compared with those who did not. Patients with PC utilization had significantly higher (42.9% versus 1.56%, p<0.001) in-hospital mortality compared ones with out. Conclusions: Between 2009 and 2018, there has been a significant increase in utilization of PC among patients with IS along with longer length of stay and higher hospital charges. Patients with PC had significantly in-hospital morality. The findings in this IS population are paradoxical to what has been seen in other critical illnesses which may be related to differences in natural history.