Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan
Received 5 March 2020
Accepted for publication 18 August 2020
Published 28 September 2020 Volume 2020:13 Pages 721—728
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Scott Fraser
Eiji Hiraoka,1 Junya Arai,1 Shunsuke Kojima,1 Yasuhiro Norisue,2 Toshihiko Suzuki,3 Yosuke Homma,4 Osamu Takahashi,5 Kotaro Obunai,6 Hiroyuki Watanabe6
1Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Chiba 279-0001, Japan; 2Department of Critical Care and Pulmonary Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Chiba 279-0001, Japan; 3Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Chiba 279-0001, Japan; 4Department of Emergency Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Chiba 279-0001, Japan; 5Department of Internal Medicine, St Luke’s International Hospital, Chuo-ku, Tokyo 104-8560, Japan; 6Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Chiba 279-0001, Japan
Correspondence: Eiji Hiraoka
Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu-city, Chiba 279-0001, Japan
Purpose: An early do-not-resuscitate (DNR) order is classified as such when it occurs within 24 hours of admission. Early DNR has been previously associated with in-hospital mortality among acute heart failure (AHF) patients and one-year mortality among patients discharged from ICU. Here, we investigate whether early DNR is associated with long-term mortality in AHF Japanese patients, by performing a retrospective cohort study.
Patients and Methods: We retrospectively investigated all patients with AHF, admitted to our hospital between April 2013 and March 2015, and survived to discharge. We obtained data on demographics, comorbidities, laboratory and echocardiography results, social background, DNR status, and outcomes (one-year death). The association of early DNR with one-year death was analyzed by multivariate logistic regression analysis.
Results: Among 370 survive to discharge patients, 48 (12%) were lost to follow up. We analyzed 322 patients. The median age was 74 years, and 80 (25%) had an early DNR order. Patients with a DNR order were older and displayed more activities of daily living (ADL)-dependence. Early DNR was associated with higher one-year mortality.
Conclusion: Early DNR was associated with one-year mortality among AHF patients. Further studies are necessary to investigate unmeasured factors associated with a worse prognosis related to early DNR among AHF patients.
Keywords: acute heart failure, early DNR, prognosis, end of life, advance care planning
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