Predictors, Treatments, and Outcomes of Do-Not-Resuscitate Status in Acute Myocardial Infarction Patients (from a Nationwide Inpatient Cohort Study)
Section snippets
Methods
The National Inpatient Sample (NIS) is the largest all-payer inpatient health care database in the United States, developed by the Healthcare Cost and Utilization Project (HCUP) and sponsored by the Agency for Healthcare Research and Quality (AHRQ).6 The NIS dataset contains hospital information on between 7 and 8 million yearly hospital discharges from 2004 onwards. Since 2012, the NIS samples discharge from all hospitals participating in HUCP, approximating a 20% stratified sample of all
Results
Between October 2015 to December 2018, 2,959,244 patients were admitted to US hospitals and during the hospitalization received a diagnosis of an AMI. Applying relevant exclusion criteria (Figure 1) produced a study cohort consisting of 2,767,549 (6.0% excluded). Of these, 339,270 (12.3%) were in the DNR group. Differences in clinical characteristics at admission between the 2 groups are presented in Table 1. Patients with a DNR order were older (median age 83 vs 67, p < 0.001), more likely to
Discussion
The results of this analysis of greater than 2.5 million US patients who presented with AMI between 2015 and 2018 revealed several important findings. First, 1 in 8 patients hospitalized with AMI had a DNR order, with more common characteristics such as being older, female, of White race and presenting as a cardiac arrest or in cardiogenic shock, but less likely to present as a STEMI. Second, patients who received a DNR order had a high burden of comorbidities such as cerebrovascular disease,
Disclosures
Giuseppe Biondi-Zoccai has consulted for Cardionovum, Innovheart, Meditrial, Opsens Medical, and Replycare. Jessica Simon is Physician Consultant, Advance Care Planning and Goals of Care, Alberta Health Services, Calgary zone. All other authors have no conflicts of interest to disclose.
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Cited by (2)
Palliative Care Use in Patients With Acute Myocardial Infarction and Do-Not-Resuscitate Status From a Nationwide Inpatient Cohort
2023, Mayo Clinic ProceedingsCitation Excerpt :Although patient preference and cultural differences are a key factor in differences in the use of palliative care, it is reassuring to see that in this high-risk cohort of patients, Black individuals are not disadvantaged in the receipt of palliative care. Although the AMI cohort of patients who have a DNR order represents a group that generally has poor outcomes and is less likely to receive invasive management compared with those without a DNR order,3 our analysis revealed that patients who receive palliative care are even less likely to undergo invasive management. One of the key facets of palliative care is āactive listening,ā in which equal importance is placed on patientsā attitude regarding their condition and understanding their fears, concerns, and priorities.16-18
Determinants of change in code status among patients with cardiopulmonary arrest admitted to the intensive care unit
2022, ResuscitationCitation Excerpt :Factors such as insurance status, ethnicity/race, religious affiliation, educational attainment and mean income were not strongly correlated with change of code status in our study population. These findings are different from previous studies in the United States19,20. Multiple factors might have contributed to the different findings.
Funding: None.
- 1
Joint first authors.