Document Detail

Impact of do-not-resuscitation orders on quality of care performance measures in patients hospitalized with acute heart failure.
MedLine Citation:
PMID:  18585500     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Heart failure (HF) is one of the leading causes of morbidity and mortality among Americans. Despite increased interest in end-of-life care, the implications of do-not-resuscitate (DNR) orders in acutely ill patients with HF remain unclear. The goals of this observational study were to describe the use of DNR orders and their impact on treatment approaches in residents of a large New England metropolitan area hospitalized with acute heart failure.
METHODS: Use of HF performance measures, including assessment of left ventricular function, use of angiotensin receptor blocking agents, anticoagulation, smoking cessation counseling, and use of nonpharmacologic strategies, was examined through review of the medical records of 4,537 metropolitan Worcester (MA) residents admitted to 11 central Massachusetts hospitals with acute HF in 1995 and 2000 according to the presence of DNR orders.
RESULTS: Patients with DNR orders were less likely to have had their left ventricular function assessed (31% vs 43%) as well as receive renin-angiotensin system blockade (49% vs 57%), anticoagulation (65% vs 78%), or nonpharmacologic interventions (87% vs 92%) as compared to patients without DNR orders. Patients with DNR orders were significantly less likely to have received any quality assurance measure for acute HF (adjusted hazard ratio 0.63, 95% confidence interval 0.40-0.99) than patients without DNR orders.
CONCLUSIONS: The use of quality assurance measures in acute HF is markedly lower in patients with DNR orders. The implications of DNR orders need to be further clarified in the treatment of patients with acute HF.
Joline L T Chen; Jonathan Sosnov; Darleen Lessard; Robert J Goldberg
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2008-04-14
Journal Detail:
Title:  American heart journal     Volume:  156     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-30     Completed Date:  2008-07-31     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  78-84     Citation Subset:  AIM; IM    
Renal Section, Boston University School of Medicine, Boston, MA 02118, USA.
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MeSH Terms
Acute Disease
Aged, 80 and over
Critical Illness / mortality,  therapy
Heart Failure / diagnosis,  mortality*,  therapy*
Hospital Mortality / trends*
Kaplan-Meier Estimate
Logistic Models
Massachusetts / epidemiology
Middle Aged
Quality Assurance, Health Care / utilization
Quality of Health Care*
Resuscitation Orders*
Risk Assessment
Survival Analysis
Treatment Outcome
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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