Palliative Care Use in Patients With Acute Myocardial Infarction and Do-Not-Resuscitate Status From a Nationwide Inpatient Cohort.

Mamas

Abstract

OBJECTIVE: To examine the predictors, treatments, and outcomes of the use of palliative care in patients hospitalized with acute myocardial infarction (AMI) who had a do-not-resuscitate (DNR) order.

PATIENTS AND METHODS: Using the National (Nationwide) Inpatient Sampling database for 2015-2018, we examined the predictors, in-hospital procedures, and outcomes of palliative care recipients among patients with AMI who had a DNR order.

RESULTS: We identified 339,270 admissions with AMI that had a DNR order, including patients who received palliative care (n=113,215 [33.4%]). Compared with patients who did not receive palliative care, these patients were more frequently younger (median age, 81 vs 83 years; P<.001), were less likely to be female (50.9% [57,626 of 113,215] vs 54.7% [123,652 of 226,055]; P<.001), and were more likely to present with cardiac arrest (11.6% [13,133 of 113,215] vs 6.9% [15,598 of 226,055]; P<.001). Patients were more likely to receive palliative care at a large (odds ratio [OR], 1.47; 95% CI, 1.44 to 1.50) or teaching (OR, 2.10; 95% CI, 2.04 to 2.16) hospitals compared with small or rural ones. Patients receiving palliative care were less likely to be treated invasively, with reduced rates of invasive coronary angiography (OR, 0.46; 95% CI, 0.45 to 0.47) and percutaneous coronary intervention (OR, 0.47; 95% CI, 0.45 to 0.48), and were more likely to die in the hospital (52.4% [59,325 of 113,215] vs 22.9% [51,766 of 226,055]).

CONCLUSION: In patients who had a DNR status and were hospitalized and received a diagnosis of AMI, only one-third received palliative care.

Citation

Mamas. (2022). Palliative Care Use in Patients With Acute Myocardial Infarction and Do-Not-Resuscitate Status From a Nationwide Inpatient Cohort. Mayo Clinic Proceedings, 98(4), 569-578. https://doi.org/10.1016/j.mayocp.2022.08.018

• Acceptance Date: Aug 23, 2022
• Publication Date: Nov 10, 2022
• Journal: Mayo Clinic Proceedings
• Print ISSN: 0025-6196
• Electronic ISSN: 1942-5546
• Publisher: Elsevier
• Volume: 98
• Issue: 4
• Pages: 569-578
• DOI: https://doi.org/10.1016/j.mayocp.2022.08.018
• Publisher URL: https://www.mayoclinicproceedings.org/article/S0025-6196(22)00514-6/fulltext