Differences and Trends in DNR Among California Inpatients With Heart Failure
Differences and Trends in DNR Among California Inpatients With Heart Failure
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DOI：
10.1016/j.cardfail.2015.12.005
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发表时间：
2016-04-01
影响因子：
6
通讯作者：
Heidenreich, Paul A.
中科院分区：
文献类型：
--
作者：
Phadke, Anuradha;Heidenreich, Paul A.
背景：不复苏（DNR）命令反映了尊重患者自主权的重要手段，同时最大限度地减少了非有益干预的风险。我们试图澄清住院心力衰竭患者的DNR订单率的趋势和差异。方法：我们使用来自加州医疗保健成本和利用数据集（2007-2010）的全州数据来确定主要出院诊断为心力衰竭的患者入院24小时内的DNR订单趋势。结果：在347,541例心力衰竭住院患者中，24小时内DNR订单率从2007年的10.4%上升到2010年的11.3% （P < 0.0001）。调整后，DNR状态与年龄、女性、白人、合并症发生率（Charlson评分）、高收入地区相关（P < 0.0001）。在公立或非营利性融资或医学院附属医院中使用DNR的可能性更大，但不是教学医院委员会的成员（均P < .001）。结论：住院心力衰竭患者DNR顺序的使用较低，但增长缓慢，且因患者人口统计学和医院特点而异。
Background: Do-not-resuscitate (DNR) orders reflect an important means of respecting patient autonomy while minimizing the risk of nonbeneficial interventions. We sought to clarify trends and differences in rates of DNR orders for patients hospitalized with heart failure.Methods: We used statewide data from California's Healthcare Cost and Utilization dataset (2007-2010) to determine trends in DNR orders within 24 hours of admission for patients with a primary discharge diagnosis of heart failure.Results: Among 347,541 hospitalizations for heart failure, the rate of DNR order within 24 hours increased from 10.4% in 2007 to 11.3% in 2010 (P < .0001). After adjustment, DNR status correlated with older age, female gender, white race, frequent comorbidities (Charlson Score), and residence in higher income area (P < .0001). DNR use was more likely in hospitals with public or nonprofit financing or medical school affiliation, but not being a member of the Council on Teaching Hospitals (all P < .001).Conclusion: DNR order use among inpatients with heart failure is low but increasing slowly and varies by patient demographics and hospital characteristics.