Clinical InvestigationCongestive Heart FailureImpact of do-not-resuscitation orders on quality of care performance measures in patients hospitalized with acute heart failure
Section snippets
Methods
The Worcester Heart Failure Study is an ongoing observational study that is examining the clinical epidemiology of acute HF in residents of the Worcester, MA, metropolitan area (2000 census estimate = 478,000) hospitalized for possible HF at all 11 greater Worcester medical centers during 1995 and 2000. Details of this project are described elsewhere.5, 9 In brief, the medical records of patients with primary and/or secondary discharge diagnoses consistent with the possible presence of HF were
Characteristics of the study population
The study sample consisted of 4,537 patients who were hospitalized with confirmed HF at all greater Worcester hospitals in 1995 and 2000 for whom DNR status could be ascertained. The mean age of the study sample was 76 years, 57% of hospitalized patients were women, and 94% were white. Approximately 30% of patients had a DNR order placed in their hospital chart at any time during the short-term hospitalization.
Characteristics of patients with DNR orders
Patients with DNR orders were more likely to be older, women, and have more comorbid
Discussion
The results of the present study, carried out in residents from a large New England metropolitan area hospitalized with clinical findings of acute HF, suggest that less than one third of patients with clinical findings of acute HF have a DNR order placed in their charts. Importantly, these patients were less likely to have had their left ventricular function measured or have been treated with appropriate angiotensin receptor blockade during their index hospitalization, as compared to patients
Summary and conclusions
The treatment of patients with HF continues to improve with technological advances and development and increased application of new treatment strategies. At the present time, recommendations for quality assurance measures provide a high standard of care and excellent treatment for all patients with acute HF. However, patients with HF continue to have a poor long-term prognosis, and end-of-life discussions remain an important aspect of the management of these high-risk patients. Physicians and
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Perceptions of care following initiation of do-not-resuscitate orders
2022, Journal of Critical CareInfections and patterns of antibiotic utilization in support and comfort care patients: A tertiary care center experience
2021, Journal of Infection and Public HealthThe effect of patient code status on surgical resident decision making: A national survey of general surgery residents
2020, Surgery (United States)Citation Excerpt :For instance, not only did surveyed physicians have significant variation in their definition of DNR, but they also reported withdrawing or withholding a spectrum of therapies including admission to an intensive care unit (ICU)1,2 and hemodialysis and intravenous fluid administration in DNR patients.1 This can result in less aggressive or suboptimal care for patients with DNR/DNI status3–6 and higher in-hospital,3,6–9 30-day,10,11 60-day,12 and 6-month7 mortality even when adjusted for clinical factors that may signify a poor prognosis. When patients are admitted to academic teaching hospitals, residents are often the first physicians and decision makers involved in their care.
Should Emergency Department Patients with End-of-Life Directives be Admitted to the ICU?
2018, Journal of Emergency MedicineCitation Excerpt :Previous studies suggest that patients with EOL care documents are treated differently, even when the care involved is not specifically addressed by their EOL care document. For example, if patients have a DNR order and are diagnosed with acute heart failure, they are less likely to be treated according to quality assurance measures (12). Similarly, patients with cardiac disease admitted for acute coronary syndrome are less aggressively treated and more likely to die (13).
This research was made possible by the cooperation of the medical records, administration, and cardiology departments of participating hospitals in the Worcester metropolitan area and through funding support provided by the National Institutes of Health, Bethesda, MD (R37 HL69874).