Abstract 16849: Factors Associated With DNR Status Among Patients Hospitalized for Heart Failure in California
Background: End of life counseling for patients with heart failure is increasingly acknowledged as an area for systems level improvement. We sought to determine use of Do-Not-Resuscitate (DNR) orders for patients hospitalized with heart failure.
Methods: We used discharge data from 2007-2010 from the state of California as part of the Health care Cost and Utilization (HCUP) dataset of the Agency for Healthcare Research and Quality. We determined patient and facility characteristics associated with a DNR order for patients with a primary discharge diagnosis of heart failure using multivariable logistic regression.
Results: Among 347,541 hospitalizations for heart failure, mean age was 71 years +/- 15, slightly more than half of the patients were male and the most were white. The overall rate of DNR was 10.8%. In adjusted analyses, the rate of DNR orders increased from 10.43% in 2007 to 11.26% in 2010 (p-value <0.0001). After adjustment (Table 1), DNR status was more likely with older age, female gender, white race, dementia, malignancy, more comorbidities (Charlson Score), higher income, public facilities, and having a medical school (but not being a member of the Council on Teaching Hospitals).
Conclusion: Racial, gender, and income differences in DNR order status for patients with heart failure were identified. Further investigation is needed to determine if patient preference or provider selection contributes to these differences. Hospitals also differ in use of DNR orders based on teaching status and financing. Additional studies are needed to determine if our findings are observed for other areas of the United States.
- © 2013 by American Heart Association, Inc.