Abstract 19488: Disparities in Care After Establishment of DNR in Female Survivors of Cardiac Arrest
Introduction: Women have poor cardiac arrest characteristics (ie. nonshockable initial rhythm, low rate of bystander CPR), have comparable rates of hospital admission after return of spontaneous circulation, but have worse rates of survival to hospital discharge.
Hypothesis: Women will have higher rates of “do not resuscitate” (DNR) orders, and therefore, have less aggressive care after establishment of this order.
Methods: We identified adult hospital admissions with a diagnosis of cardiac arrest (ICD-9 427.5) from the 2010 California State Inpatient Database. Demographics, procedures and hospital disposition were analyzed via descriptive statistics. Multivariable logistic regression was utilized to test for associations. The primary outcome was early DNR, characterized as within the first 24 hours of admission.
Results: We analyzed 7,703 patients who suffered cardiac arrest and survived to hospital admission. More women had establishment of a DNR during the first 24 hours of their admission (22.5% vs. 17.8%; p<0.01). Patients with a DNR were older, 60% Caucasian, had shorter length of stay, and had fewer procedures performed (Table 1). There was no difference between women and men with DNRs and the procedures utilized: cardiac catheterization (3.5% vs. 5.2%; p=0.10), ICD placement (1.7% vs. 2.6%; p=0.25), hemodialysis (6.4% vs. 5.6%; p=0.50), echocardiogram (4.5% vs. 4.8%; p=0.80), and electroencephalogram (1.9% vs. 2.3%; p=0.50). By multivariable analysis controlling for age and race, women had a greater chance of having a DNR established during the first 24 hours of their hospital admission after cardiac arrest (OR 1.31; 95% CI 1.17-1.48).
Conclusion: Female survivors of cardiac arrest have a higher risk of having a DNR established within the first 24 hours of care, and this results in fewer procedures than individuals who do not have a DNR established. There are no differences in the procedures received for women vs. men after the establishment of a DNR.
Author Disclosures: S.M. Perman: None.
- © 2014 by American Heart Association, Inc.