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Goals of care changes after acute ischaemic stroke: decision frequency and predictors
  1. Raphaela Hausammann1,
  2. Errikos Maslias2,
  3. Michael Amiguet3,
  4. Ralf J Jox4,
  5. Gian Domenico Borasio5 and
  6. Patrik Michel2
  1. 1 Internal medicine, Private practice, Lenzerheide, Switzerland
  2. 2 Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
  3. 3 University of Lausanne, Lausanne, Switzerland
  4. 4 Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  5. 5 Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Vaud, Switzerland
  1. Correspondence to Dr Errikos Maslias, Lausanne University Hospital, Lausanne, Switzerland; Errikos.Maslias{at}chuv.ch

Abstract

Objectives Little is known about the factors leading to a change in goals of care (CGC) in patients with an acute ischaemic stroke (AIS). Our aim was to analyse the proportion and outcome of such patients and identify medical predictors of a CGC during acute hospitalisation.

Methods We retrospectively reviewed all patients who had an AIS over a 13-year period from the prospectively constructed Acute Stroke Registry and Analysis of Lausanne. We compared patients with a CGC during the acute hospital phase to all other patients and identified associated clinical and radiological variables using logistic regression analysis.

Results A CGC decision was taken in 440/4264 (10.3%) consecutive patients who had an AIS. The most powerful acute phase predictors of a CGC were transit through the intensive care unit, older age, pre-existing disability, higher stroke severity and initial decreased level of consciousness. Adding subacute phase variables, we also identified active oncological disease, fever and poor recanalisation as predictors. 76.6% of the CGC patients died in the stroke unit and 1.0% of other patients, and 30.5% of patients with a CGC received a palliative care consultation. At 12 months, 93.6% of patients with CGC had died, compared with 10.1% of non-CGC patients.

Conclusions Over three-quarters of AIS patients with CGC died in hospital, but less than a third received a palliative care consultation. The identified clinical and radiological predictors of a CGC may allow physicians to initiate timely the decision-making process for a possible CGC.

  • clinical decisions
  • end of life care
  • stroke
  • quality of life

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • RH and EM contributed equally.

  • Contributors RH and EM studied the concept and design and helped in analysis and interpretation and preparation of the article. MA carried out data analysis and interpretation and helped in preparation of the article. GDB and RJJ contributed to the conception and design and helped in the interpretation of data. PM studied the concept and design and helped in data acquisition, analysis and interpretation, critical revision of the article for important intellectual content and study supervision. All authors reviewed and edited the manuscript and approved the final version of the manuscript. PM is responsible for the overall content as the guarantor.

  • Funding PM received grants from Swiss National Science Foundation, Swiss Heart Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.