AHA statement calls for broader use of palliative care for stroke survivors

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Integrating palliative care into post-stroke treatment can significantly improve the quality of life for stroke survivors and their families, according to a new scientific statement from the American Heart Association (AHA). Despite its potential benefits, palliative care remains underutilized, particularly among Black, Hispanic and Asian populations, the AHA said.

“Stroke is often thought of as an event that is over quickly, but that is not true,” Claire J. Creutzfeldt, MD, chair of the writing group and associate professor of neurology at the University of Washington in Seattle, said in an AHA release. “Even though the majority of strokes are not immediately life-threatening, every stroke is life-altering, and every stroke requires high-quality, person-centered care. Integrating palliative care principles into stroke care is fundamental for all patients and at every stage after a stroke.”

The statement, published in the journal Stroke, emphasized the need to incorporate palliative care into all stages of stroke care. This includes managing symptoms, addressing psychosocial health, navigating complex health care systems and preparing for end-of-life care when necessary.

Stroke in the U.S.

A stroke occurs when a blood vessel to the brain is blocked by a clot or ruptures, cutting off blood flow and causing brain cells to die. It is a leading cause of adult disability in the U.S. and the fifth leading cause of death. Around 800,000 people in the U.S. have a stroke each year, and 160,000 die as a result, according to the AHA’s 2024 Heart Disease and Stroke Statistics report.

Advances in stroke treatment have led to an increase in survival rates, but long-term challenges including cognitive and physical disabilities often persist. These challenges can extend to caregivers, who may feel overwhelmed by their responsibilities.

Holistic and individualized care

Palliative care focuses on a comprehensive assessment of physical, emotional, psychosocial and spiritual needs. A multidimensional assessment includes a comprehensive evaluation of the stroke’s impact on the patient and their family, their expectations post-stroke and their values and goals of care.
“It’s essential to recognize the impact of illness and disability on someone’s quality of life and understand that treatment decisions will vary from patient to patient, based on their values, their beliefs and their culture,” Creutzfeldt said. “An individualized and culturally sensitive approach to assessment and management is always best. Additionally, the palliative care needs of patients and their families or care partners after a stroke fluctuate over the course of their illness based on events, symptoms, changes in function and stage of the illness.”

In addition to proactive evaluation of patient and family needs, emotional, spiritual and psychosocial support are critical components, according to the statement. The writing group proceeded to highlight the success of interventions that address the needs of both patients and caregivers. The statement includes a palliative care checklist and screening tools to help recognize and manage these needs.

Gaps in post-acute and end-of-life care

Research on palliative care for patients and family after hospital discharge—known as the post-acute care phase—is limited. Post-stroke pain is most severe four to six months and over two years post-stroke, yes it remains widely under-diagnosed and under-treated. Discharge care also varies widely, with approximately 34-45% of stroke patients sent home without additional services and only a small percentage (0.4-8.9%) referred to palliative care.

Although palliative care is available during any stage of illness, hospice care—a specific type of palliative care—is often reserved for patients with a life expectancy of six months or less. Many patients with severe strokes, however, do not qualify for hospice despite significant needs for symptom management and comfort care.

Disparities in stroke care

The statement underscores inequities in palliative care access, particularly among minority populations. Black patients had 77% lower odds and Hispanic patients had 70% lower odds of completing advanced directives compared to white people. Black, Hispanic and Asian patients are also less frequently discharged to hospice care.

Although cultural differences may play a role, systemic inequities are significant contributors, the statement noted. Studies show that the hospital where care is received is a major factor in whether patients are referred for palliative services.

The AHA’s 2023 scientific statement on reducing racial and ethnic inequities in stroke care highlights tailored strategies to address these disparities. Additional research is needed to understand how clinicians, hospitals and health care systems can mitigate these inequities.

This statement from AHA is intended to raise awareness of palliative care’s role in stroke recovery. The statement’s authors emphasized the importance of individualized, culturally sensitive approaches to addressing the varied needs of stroke survivors and their families. The AHA noted that, although the statement informs clinical practice, it does not provide formal treatment recommendations. Instead, it highlights areas primed for further research and calls for systemic changes to reduce barriers to palliative care access.