| Impact of do-not-resuscitation orders on quality of care performance measures in patients hospitalized with acute heart failure. | |
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MedLine Citation:
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PMID: 18585500 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Joline L T Chen; Jonathan Sosnov; Darleen Lessard; Robert J Goldberg |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2008-04-14 |
Journal Detail:
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Title: American heart journal Volume: 156 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2008 Jul |
Date Detail:
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Created Date: 2008-06-30 Completed Date: 2008-07-31 Revised Date: 2010-08-10 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 78-84 Citation Subset: AIM; IM |
Affiliation:
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Renal Section, Boston University School of Medicine, Boston, MA 02118, USA. joline.chen@bmc.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Aged, 80 and over Critical Illness / mortality, therapy Female Heart Failure / diagnosis, mortality*, therapy* Hospital Mortality / trends* Hospitalization* Humans Kaplan-Meiers Estimate Logistic Models Male Massachusetts / epidemiology Middle Aged Probability Quality Assurance, Health Care / utilization Quality of Health Care* Registries Resuscitation Orders* Risk Assessment Survival Analysis Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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R37 HL069874-06/HL/NHLBI NIH HHS; R37 HL69874/HL/NHLBI NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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