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Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in 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 investi...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532062/ https://www.ncbi.nlm.nih.gov/pubmed/33061541 http://dx.doi.org/10.2147/IJGM.S252651 |
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author | Hiraoka, Eiji Arai, Junya Kojima, Shunsuke Norisue, Yasuhiro Suzuki, Toshihiko Homma, Yosuke Takahashi, Osamu Obunai, Kotaro Watanabe, Hiroyuki |
author_facet | Hiraoka, Eiji Arai, Junya Kojima, Shunsuke Norisue, Yasuhiro Suzuki, Toshihiko Homma, Yosuke Takahashi, Osamu Obunai, Kotaro Watanabe, Hiroyuki |
author_sort | Hiraoka, Eiji |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7532062 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-75320622020-10-14 Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan Hiraoka, Eiji Arai, Junya Kojima, Shunsuke Norisue, Yasuhiro Suzuki, Toshihiko Homma, Yosuke Takahashi, Osamu Obunai, Kotaro Watanabe, Hiroyuki Int J Gen Med Original Research 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. Dove 2020-09-28 /pmc/articles/PMC7532062/ /pubmed/33061541 http://dx.doi.org/10.2147/IJGM.S252651 Text en © 2020 Hiraoka et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Hiraoka, Eiji Arai, Junya Kojima, Shunsuke Norisue, Yasuhiro Suzuki, Toshihiko Homma, Yosuke Takahashi, Osamu Obunai, Kotaro Watanabe, Hiroyuki Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan |
title | Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan |
title_full | Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan |
title_fullStr | Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan |
title_full_unstemmed | Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan |
title_short | Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan |
title_sort | early dnr order and long-term prognosis among patients hospitalized for acute heart failure: single-center cohort study in japan |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532062/ https://www.ncbi.nlm.nih.gov/pubmed/33061541 http://dx.doi.org/10.2147/IJGM.S252651 |
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