Resuscitation preferences in community patients with heart failure

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18 Citations (Scopus)

Abstract

Background-Little is known about the resuscitation preferences of patients with heart failure, how they may change over the course of the disease, and their association with mortality. Methods and Results-We enrolled consecutive Southeastern Minnesota residents with heart failure from October 2007 through September 2011 into a longitudinal study. Information on resuscitation preferences (Full Code or do-not-resuscitate [DNR]) was obtained from medical records through April 1, 2013. Of 608 patients enrolled, 237 died during follow-up. At enrollment, most patients (73.4%) were Full Code, whereas at death, most (78.5%) were DNR. The independent predictors of DNR status at enrollment were advanced age, chronic obstructive pulmonary disease, previous malignancy, and decreased mobility. Patients who were DNR were at increased risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.48-2.73; P<0.001), but this risk did not persist after adjusting for age, comorbidity, and self- perceived general health (hazard ratio, 0.97; 95% confidence interval, 0.74-1.30; P=0.83). Of 481 patients who were Full Code during follow-up, 22 (4.6%) received cardiopulmonary resuscitation for an in-hospital cardiac arrest. Eight patients survived to hospital discharge; only 2 (9.1% of those receiving cardiopulmonary resuscitation) made a complete recovery and returned home. The median time from a final decision to be DNR until death was only 37 (7,70) days. Conclusions-The resuscitation preferences of patients with heart failure seem to be driven by the decline in clinical status that often accompanies advanced age and multimorbidity. Furthermore, these data suggest that electing DNR status does not independently affect a patient's risk of death.

Original languageEnglish (US)
Pages (from-to)353-359
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume7
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Resuscitation
Heart Failure
Patient Preference
Cardiopulmonary Resuscitation
Comorbidity
Confidence Intervals
Heart Arrest
Chronic Obstructive Pulmonary Disease
Medical Records
Longitudinal Studies
Mortality
Health
Neoplasms

Keywords

  • Cardiopulmonary resuscitation
  • Epidemiology
  • Heart failure
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Resuscitation preferences in community patients with heart failure",
abstract = "Background-Little is known about the resuscitation preferences of patients with heart failure, how they may change over the course of the disease, and their association with mortality. Methods and Results-We enrolled consecutive Southeastern Minnesota residents with heart failure from October 2007 through September 2011 into a longitudinal study. Information on resuscitation preferences (Full Code or do-not-resuscitate [DNR]) was obtained from medical records through April 1, 2013. Of 608 patients enrolled, 237 died during follow-up. At enrollment, most patients (73.4{\%}) were Full Code, whereas at death, most (78.5{\%}) were DNR. The independent predictors of DNR status at enrollment were advanced age, chronic obstructive pulmonary disease, previous malignancy, and decreased mobility. Patients who were DNR were at increased risk of death (unadjusted hazard ratio, 2.03; 95{\%} confidence interval, 1.48-2.73; P<0.001), but this risk did not persist after adjusting for age, comorbidity, and self- perceived general health (hazard ratio, 0.97; 95{\%} confidence interval, 0.74-1.30; P=0.83). Of 481 patients who were Full Code during follow-up, 22 (4.6{\%}) received cardiopulmonary resuscitation for an in-hospital cardiac arrest. Eight patients survived to hospital discharge; only 2 (9.1{\%} of those receiving cardiopulmonary resuscitation) made a complete recovery and returned home. The median time from a final decision to be DNR until death was only 37 (7,70) days. Conclusions-The resuscitation preferences of patients with heart failure seem to be driven by the decline in clinical status that often accompanies advanced age and multimorbidity. Furthermore, these data suggest that electing DNR status does not independently affect a patient's risk of death.",
keywords = "Cardiopulmonary resuscitation, Epidemiology, Heart failure, Survival",
author = "Dunlay, {Shannon M} and Swetz, {Keith M.} and Redfield, {Margaret May} and Paul Mueller and Roger, {Veronique Lee}",
year = "2014",
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T1 - Resuscitation preferences in community patients with heart failure

AU - Dunlay, Shannon M

AU - Swetz, Keith M.

AU - Redfield, Margaret May

AU - Mueller, Paul

AU - Roger, Veronique Lee

PY - 2014

Y1 - 2014

N2 - Background-Little is known about the resuscitation preferences of patients with heart failure, how they may change over the course of the disease, and their association with mortality. Methods and Results-We enrolled consecutive Southeastern Minnesota residents with heart failure from October 2007 through September 2011 into a longitudinal study. Information on resuscitation preferences (Full Code or do-not-resuscitate [DNR]) was obtained from medical records through April 1, 2013. Of 608 patients enrolled, 237 died during follow-up. At enrollment, most patients (73.4%) were Full Code, whereas at death, most (78.5%) were DNR. The independent predictors of DNR status at enrollment were advanced age, chronic obstructive pulmonary disease, previous malignancy, and decreased mobility. Patients who were DNR were at increased risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.48-2.73; P<0.001), but this risk did not persist after adjusting for age, comorbidity, and self- perceived general health (hazard ratio, 0.97; 95% confidence interval, 0.74-1.30; P=0.83). Of 481 patients who were Full Code during follow-up, 22 (4.6%) received cardiopulmonary resuscitation for an in-hospital cardiac arrest. Eight patients survived to hospital discharge; only 2 (9.1% of those receiving cardiopulmonary resuscitation) made a complete recovery and returned home. The median time from a final decision to be DNR until death was only 37 (7,70) days. Conclusions-The resuscitation preferences of patients with heart failure seem to be driven by the decline in clinical status that often accompanies advanced age and multimorbidity. Furthermore, these data suggest that electing DNR status does not independently affect a patient's risk of death.

AB - Background-Little is known about the resuscitation preferences of patients with heart failure, how they may change over the course of the disease, and their association with mortality. Methods and Results-We enrolled consecutive Southeastern Minnesota residents with heart failure from October 2007 through September 2011 into a longitudinal study. Information on resuscitation preferences (Full Code or do-not-resuscitate [DNR]) was obtained from medical records through April 1, 2013. Of 608 patients enrolled, 237 died during follow-up. At enrollment, most patients (73.4%) were Full Code, whereas at death, most (78.5%) were DNR. The independent predictors of DNR status at enrollment were advanced age, chronic obstructive pulmonary disease, previous malignancy, and decreased mobility. Patients who were DNR were at increased risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.48-2.73; P<0.001), but this risk did not persist after adjusting for age, comorbidity, and self- perceived general health (hazard ratio, 0.97; 95% confidence interval, 0.74-1.30; P=0.83). Of 481 patients who were Full Code during follow-up, 22 (4.6%) received cardiopulmonary resuscitation for an in-hospital cardiac arrest. Eight patients survived to hospital discharge; only 2 (9.1% of those receiving cardiopulmonary resuscitation) made a complete recovery and returned home. The median time from a final decision to be DNR until death was only 37 (7,70) days. Conclusions-The resuscitation preferences of patients with heart failure seem to be driven by the decline in clinical status that often accompanies advanced age and multimorbidity. Furthermore, these data suggest that electing DNR status does not independently affect a patient's risk of death.

KW - Cardiopulmonary resuscitation

KW - Epidemiology

KW - Heart failure

KW - Survival

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