What Is the Role of Palliative Care in Stroke?

Introduction and Scope of the Problem

Every year in the United States, approximately 795,000 people experience a stroke, meaning someone has a stroke approximately every 40 seconds. Of all strokes, the majority (87%) are ischemic, with 10% due to intracerebral hemorrhage and the remaining 3% due to subarachnoid hemorrhage. Although in recent years stroke has fallen from the third to the fifth leading cause of death in the United States mainly due to a reduced incidence of stroke and advances in treatment of acute stroke, it remains a significant cause of morbidity and mortality and a leading cause of serious long-term disability in adults.

Among those who survive an acute stroke, the majority will be left with some degree of physical, cognitive, or psychological disability, with 15% to 30% remaining permanently disabled and 20% requiring institutional care at 3 months after the event.

Because palliative care focuses on improving quality of life throughout the trajectory of serious illness, the role of palliative medicine in stroke has the potential to be significant—benefitting patients, families, and caregivers at multiple stages of illness and in multiple care settings. Given the different outcomes and degree of disability in patients who have had a stroke, the role of palliative care may vary depending on whether the patient is in the acute poststroke period or has progressed to a more chronic, disabled state.

Despite having a range of palliative care needs throughout their disease course, stroke patients remain an underserved population in the palliative care setting. In data from the national inpatient sample (a cross-sectional, all payer, inpatient claims dataset) from 2010 to 2012, among 395,411 stroke patients, only 6.2% had a palliative care encounter. There was wide variability in the use of palliative care, with higher use among those who were: older; women; identified as White race; had a hemorrhagic stroke; and were cared for at larger, nonprofit hospitals.

Summary of Evidence Regarding Treatment Recommendations