Do-not-resuscitate orders in patients hospitalized with acute myocardial infarction - The Worcester Heart Attack Study
Do-not-resuscitate orders in patients hospitalized with acute myocardial infarction - The Worcester Heart Attack Study
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DOI：
10.1001/archinte.164.7.776
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发表时间：
2004-04-12
影响因子：
--
通讯作者：
Gore, JM
中科院分区：
文献类型：
--
作者：
Jackson, EA;Yarzebski, JL;Gore, JM
背景：冠心病是美国人死亡的主要原因。尽管人们对临终关怀的兴趣越来越大，但关于在急性心脏病患者中使用不复苏（DNR）命令的数据仍然非常有限。本研究的目的是描述急性心肌梗死患者DNR命令的使用、治疗方法和医院结局。方法：研究样本包括1991年至1999年5年期间在马萨诸塞州伍斯特市所有大城市地区医院住院的4621名急性心肌梗死患者。在研究的十年中，观察到DNR订单的使用显着增加（从1991年的16%。1999年为25%）。老年人、女性和既往有糖尿病或中风的患者更可能有DNR订单。即使DNR命令是在住院期间较晚时发出的，收到DNR命令的患者接受有效心脏药物治疗的可能性也明显较小。不到1%的患者在入院前有DNR订单。与DNR订单的患者住院期间死亡的可能性显着高于没有DNR订单的患者（44%比5%）。结论：这项社区范围内的研究结果表明，在过去的十年中，急性心肌梗死住院患者使用DNR订单的增加。使用某些心脏治疗和医院的结果是不同的患者与无DNR订单。需要进一步努力来描述急性冠状动脉疾病患者使用DNR命令的特征。
Background: Coronary heart disease is the leading cause of death in Americans. Despite increased interest in end-of-life care, data regarding the use of do-not-resuscitate (DNR) orders in acutely ill cardiac patients remain extremely limited. The objectives of this study were to describe use of DNR orders, treatment approaches, and hospital outcomes in patients with acute myocardial infarction.Methods: The study sample consisted of 4621 residents hospitalized with acute myocardial infarction at all metropolitan Worcester, Mass, area hospitals in five 1-year periods from 1991 to 1999.Results: Significant increases in the use of DNR orders were observed during the study decade (from 16% in 1991. to 25% in 1999). The elderly, women, and patients with previous diabetes mellitus or stroke were more likely to have DNR orders. Patients with DNR orders were significantly less likely to be treated with effective cardiac medications, even if the DNR order occurred late in the hospital stay. Less than 1% of patients were noted to have DNR orders before hospital admission. Patients with DNR orders were significantly more likely to die during hospitalization than patients without DNR orders (44% vs 5%).Conclusions: The results of this community-wide study suggest increased use of DNR orders in patients hospitalized with acute myocardial infarction during the past decade. Use of certain cardiac therapies and hospital outcomes are different between patients with and without DNR orders. Further efforts are needed to characterize the use of DNR orders in patients with acute coronary disease.