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Increase in the proportion of patients hospitalized with acute myocardial infarction with do-not-resuscitate orders already in place between 2001 and 2007: a nonconcurrent prospective study
Meyers Primary Care Institute Publications and Presentations
  • Jane S. Saczynski, University of Massachusetts Medical School
  • Ezra Gabbay, Tufts Medical School
  • David D. McManus, University of Massachusetts Medical School
  • Richard H. McManus, University of Massachusetts Medical School
  • Joel M. Gore, University of Massachusetts Medical School
  • Jerry H. Gurwitz, University of Massachusetts Medical School
  • Darleen M. Lessard, University of Massachusetts Medical School
  • Robert J. Goldberg, University of Massachusetts Medical School
UMMS Affiliation
Department of Medicine, Division of Geriatric Medicine; Department of Medicine, Division of Cardiovascular Medicine; Department of Quantitative Health Sciences; Meyers Primary Care Institute
Date
10-19-2012
Document Type
Article
Medical Subject Headings
Myocardial Infarction; Resuscitation Orders
Abstract
BACKGROUND AND OBJECTIVE: Shared decision making and advance planning in end-of-life decisions have become increasingly important aspects of the management of seriously ill patients. Here, we describe the use and timing of do-not-resuscitate (DNR) orders in patients hospitalized with acute myocardial infarction (AMI). STUDY DESIGN AND SETTING: The nonconcurrent prospective study population consisted of 4182 patients hospitalized with AMI in central Massachusetts in four annual periods between 2001 and 2007. RESULTS: One-quarter (25%) of patients had a DNR order written either prior to or during hospitalization. The frequency of DNR orders remained constant (24% in 2001; 26% in 2007). Among patients with DNR orders, there was a significant increase in orders written prior to hospitalization (2001: 9%; 2007: 55%). Older patients and those with a medical history of heart failure or myocardial infarction were more likely to have prior DNR orders than respective comparison groups. Patients with prior DNR orders were less likely to die 1 month after hospitalization than patients whose DNRs were written during hospitalization. CONCLUSION: Although the use of DNR orders in patients hospitalized with AMI was stable during the period under study, in more recent years, patients are increasingly being hospitalized with DNR orders already in place.
Comments

Citation: Clin Epidemiol. 2012;4:267-74. doi: 10.2147/CLEP.S32034. Epub 2012 Oct 19. Link to article on publisher's site

© 2012 Saczynski et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

Related Resources
Link to Article in PubMed
PubMed ID
23118551
Citation Information
Jane S. Saczynski, Ezra Gabbay, David D. McManus, Richard H. McManus, et al.. "Increase in the proportion of patients hospitalized with acute myocardial infarction with do-not-resuscitate orders already in place between 2001 and 2007: a nonconcurrent prospective study" Vol. 4 (2012) ISSN: 1179-1349 (Linking)
Available at: http://works.bepress.com/robert_goldberg/367/