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
Jane S Saczynski,1–3 Ezra Gabbay,4 David D McManus,1–3 Richard McManus,3 Joel M Gore,1,3 Jerry H Gurwitz,1–3 Darleen Lessard,3 Robert J Goldberg31Department of Medicine, University of Massachusetts Medical School, Worcester, 2Meyers Primary Care Institute, W...
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2012-10-01
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| Series: | Clinical Epidemiology |
| Online Access: | http://www.dovepress.com/increase-in-the-proportion-of-patients-hospitalized-with-acute-myocard-a11310 |
| _version_ | 1818518093034422272 |
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| author | Saczynski JS Gabbay E McManus DD McManus R Gore JM Gurwitz JH Lessard D Goldberg RJ |
| author_facet | Saczynski JS Gabbay E McManus DD McManus R Gore JM Gurwitz JH Lessard D Goldberg RJ |
| author_sort | Saczynski JS |
| collection | DOAJ |
| description | Jane S Saczynski,1–3 Ezra Gabbay,4 David D McManus,1–3 Richard McManus,3 Joel M Gore,1,3 Jerry H Gurwitz,1–3 Darleen Lessard,3 Robert J Goldberg31Department of Medicine, University of Massachusetts Medical School, Worcester, 2Meyers Primary Care Institute, Worcester, 3Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 4Division of Nephrology, Tufts Medical School, Boston, MA, USABackground 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.Keywords: epidemiology, myocardial infarction, survival, end of life, longitudinal, cardiology |
| first_indexed | 2024-12-11T01:05:22Z |
| format | Article |
| id | doaj.art-0a995e975ac649b7a8be14802278909c |
| institution | Directory Open Access Journal |
| issn | 1179-1349 |
| language | English |
| last_indexed | 2024-12-11T01:05:22Z |
| publishDate | 2012-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Epidemiology |
| spelling | doaj.art-0a995e975ac649b7a8be14802278909c2022-12-22T01:26:11ZengDove Medical PressClinical Epidemiology1179-13492012-10-012012Issue 1267274Increase 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 studySaczynski JSGabbay EMcManus DDMcManus RGore JMGurwitz JHLessard DGoldberg RJJane S Saczynski,1–3 Ezra Gabbay,4 David D McManus,1–3 Richard McManus,3 Joel M Gore,1,3 Jerry H Gurwitz,1–3 Darleen Lessard,3 Robert J Goldberg31Department of Medicine, University of Massachusetts Medical School, Worcester, 2Meyers Primary Care Institute, Worcester, 3Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 4Division of Nephrology, Tufts Medical School, Boston, MA, USABackground 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.Keywords: epidemiology, myocardial infarction, survival, end of life, longitudinal, cardiologyhttp://www.dovepress.com/increase-in-the-proportion-of-patients-hospitalized-with-acute-myocard-a11310 |
| spellingShingle | Saczynski JS Gabbay E McManus DD McManus R Gore JM Gurwitz JH Lessard D Goldberg RJ 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 Clinical Epidemiology |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | http://www.dovepress.com/increase-in-the-proportion-of-patients-hospitalized-with-acute-myocard-a11310 |
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