Resuscitation Choices Change Over Time in Heart Failure
Predictors of DNR state include advanced age, COPD, previous malignancy, decreased mobility
WEDNESDAY, May 21, 2014 (HealthDay News) -- For patients with heart failure, resuscitation preferences seem to change over time and are influenced by advancing age and comorbidity, according to a study published online May 13 in Circulation: Cardiovascular Quality and Outcomes.
Shannon M. Dunlay, M.D., from the Mayo Clinic in Rochester, Minn., and colleagues examined resuscitation preferences for 608 Southeastern Minnesota residents with heart failure, enrolled into a longitudinal study from October 2007 through September 2011. Information on resuscitation preferences was extracted from medical records.
The researchers found that 237 of the patients died during follow-up. Most patients (73.4 percent) were Full Code at enrollment, while 78.5 percent were do-not-resuscitate (DNR) at death. Advanced age, chronic obstructive pulmonary disease, previous malignancy, and decreased mobility were identified as independent predictors of DNR status at enrollment. The risk of death was increased for patients who were DNR (unadjusted hazard ratio, 2.03; P < 0.001), but after adjustment for age, comorbidity, and self-perceived general health, the risk did not persist (hazard ratio, 0.97; P = 0.83). Only 4.6 percent of the 481 patients who were Full Code during follow-up received cardiopulmonary resuscitation for an in-hospital cardiac arrest. Of these patients, eight survived to discharge, and only two made a complete recovery and returned home. There was a median of 37 days from final decision to be DNR until death.
"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," the authors write. "Furthermore, these data suggest that electing DNR status does not independently affect a patient's risk of death."