Introduction Fifty-five percent of people with multiple sclerosis (pwMS) will die in hospital, above the national average. This study aimed to determine factors that impact place of death for pwMS.

Methods Retrospective sequential notes review from the UK MS Tissue Bank.

Results Thirty notes were reviewed from 18/06/12% to 08/09/16. 53% died in hospital, 23% in nursing homes, 13% at home and 10% in hospices. Health interventions increased in year of death versus year prior to death in community (p=0.0369) and primary care (p=0.002) but not in secondary care but were not associated with a non-hospital death (NHD). Recognition of dying (73%, p=0.0024) and having an advanced care plan (ACP) (67%, p=0.0003) were associated with NHD. Family involvement was associated with recognition of dying (p=0.0146) but not with NHD. Multivariable analysis found recognition a person is dying and having an ACP were independently predictive of NHD (R2=0.52, p=0.034). The mean time prior to death of having an ACP (9.6±8.1 months) was months prior from when dying was recognised (17.4±27 days, p=0.0004).

Conclusion Having an ACP and recognition a pwMS is dying are key factors to achieving a NHD. This study highlights the challenges to reducing hospital deaths in MS.