&lt;p&gt;Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan&lt;/p&gt;

Hiraoka, Eiji; Arai, Junya; Kojima, Shunsuke; Norisue, Yasuhiro; Suzuki, Toshihiko; Homma, Yosuke; Takahashi, Osamu; Obunai, Kotaro; Watanabe, Hiroyuki

doi:10.2147/ijgm.s252651

Cited by 3 publications

(3 citation statements)

References 26 publications

(36 reference statements)

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“…We found no differences between sexes in adjusted 1-year mortality after ICH. However, DNR orders may worsen outcomes independently in ICH patients ( 29 – 32 ) and it is possible that the increased use of DNR orders in women in our study may have contributed to a decreased survival.…”

Section: Discussionmentioning

confidence: 82%

Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage

et al. 2022

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Introduction and AimData remain limited on sex-differences in patients with oral anticoagulant (OAC)-related intracerebral hemorrhage (ICH). We aim to explore similarities and differences in risk factors, acute presentation, treatments, and outcome in men and women admitted with OAC-related ICH.MethodThis study was a retrospective observational study based on 401 consecutive patients with OAC-related ICH admitted within 24 h of symptom onset. The study was registered on osf.io. We performed logarithmic regression and cox-regression adjusting for age, hematoma volume, Charlson Comorbidity Index (CCI), and pre-stroke modified Ranking Scale (mRS). Gender and age were excluded from CHA2DS2-VASc and CCI was not adjusted for age.ResultsA total of 226 men and 175 women were identified. More men were pre-treated with vitamin K-antagonists (73.5% men vs. 60.6% women) and more women with non-vitamin K-antagonist oral anticoagulants (26.5% men vs. 39.4% women), p = 0.009. Women were older (mean age 81.9 vs. 76.9 years, p < 0.001). CHA2DS2-VASc and CCI were similar in men and women.Hematoma volumes (22.1 ml in men and 19.1 ml in women) and National Institute of Health Stroke Scale (NIHSS) scores (13 vs. 13) were not statistically different, while median Glasgow Coma Scale (GCS) was lower in women, (14 [8;15] vs. 14 [10;15] p = 0.003).Women's probability of receiving reversal agents was significantly lower (adjusted odds ratio [aOR] = 0.52, p = 0.007) but not for surgical clot removal (aOR = 0.56, p = 0.25). Women had higher odds of receiving do-not-resuscitate (DNR) orders within a week (aOR = 1.67, p = 0.04). There were no sex-differences in neurological deterioration (aOR = 1.48, p = 0.10), ability to walk at 3 months (aOR = 0.69, p = 0.21) or 1-year mortality (adjusted hazard ratio = 1.18, p = 0.27).ConclusionSignificant sex-differences were observed in age, risk factors, access to treatment, and DNRs while no significant differences were observed in comorbidity burden, stroke severity, or hematoma volume. Outcomes, such as adjusted mortality, ability to walk, and neurological deterioration, were comparable. This study supports the presence of sex-differences in risk factors and care but not in presentation and outcomes.

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Section: Discussionmentioning

confidence: 82%

Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage

et al. 2022

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“…Usually, patients decide to sign DNAR forms before high-risk operations such as neurosurgical operations which may lead to a coma or a vegetative state. Other reasons for deciding to sign it is when a person is in the terminal stage of a chronic illness which is uncurable, so the performance of CPR, if needed, will only prolong the suffering of the patient for some time [ 6 , 7 ]. The use of the DNAR protocol is more prevalent among emergency patients and is associated with age and non-trauma presentation [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Public Attitude towards Implementing DNAR and a Stance on Pediatric DNAR in Poland—A Prospective Survey Study

Timler,

Kempa,

Kozłowski

et al. 2024

JCM

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Background: Do not attempt resuscitation (DNAR) is a document signed by a patient, which states that they do not want to be resuscitated. In Poland, DNAR is not regulated by law. We aimed to assess people’s perceptions on DNAR and pediatric DNAR in Poland. Methods: An anonymous survey was distributed via the snowball sampling method in different voivodeships in Poland in the years 2014–2018. The survey consisted of questions regarding knowledge and attitudes towards DNAR and pediatric DNAR. Results: A total of 1049 responses were collected. Moreover, 82% support introducing DNAR in Poland, but 78% believe that this is not a pressing issue. In a general question, 46% of respondents believe that DNAR should be obtainable only for adults. However, in a specific question, this number drops to 17%, with people agreeing for pediatric DNAR if it contains a boundary—23% agree if both parents agree to the solution and 45% if both parents and the child’s doctor agree to it. Conclusions: Even though someone supports DNAR, it does not mean that they support pediatric DNAR. People outside the medical community are more likely to be against DNAR. Giving a boundary in using pediatric DNAR may lead to the ease of its implementation in a legislative manner.

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“…Previous studies reported that the mortality rate was higher in patients who signed a DNR order in the intensive care unit (ICU) [ 4 , 8 ]. Studies have also shown that a DNR order was associated with high mortality in patients with heart failure and sepsis [ 9 , 10 , 11 ]. Hence, whether a DNR should be determined very early, while patients are still in the emergency department (ED), remains controversial.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Do-Not-Resuscitate Order in the Emergency Department on Respiratory Failure after ICU Admission

et al. 2022

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(1) Background: It has been hypothesized that a discrepancy exists in the understanding of a do-not-resuscitate (DNR) order among physicians. We hypothesized that a DNR order signed in the emergency department (ED) could influence the patients’ prognosis after intensive care unit (ICU) admission. (2) Methods: We included patients older than 17 years, who visited the emergency department for non-traumatic disease, who had respiratory failure, required ventilator support, and were admitted to the ICU between January 2010 and December 2016. The associations between DNR and mortality, hospital length of stay (LOS), and medical fees were analyzed. Prolonged hospital LOS was defined as hospital stay ≥75th percentile (≥26 days for the study). Patients were classified as those who did and did not sign a DNR order. A 1:4 propensity score matching was conducted for demographics, comorbidities, and etiology. (3) Results: The study enrolled a total of 1510 patients who signed a DNR and 6040 patients who did not sign a DNR. The 30-day mortality rates were 47.4% and 28.0% among patients who did and did not sign a DNR, respectively. A DNR order was associated with mortality after adjusting for confounding factors (hazard ratio, 1.9; confidence interval, 1.70–2.03). It was also a risk factor for prolonged hospital LOS in survivors (odds ratio, 1.2; confidence interval, 1.02–1.44). Survivors who signed a DNR order were charged higher medical fees than those who did not sign a DNR (217,159 vs. 245,795 New Taiwan Dollars, p < 0.001). (4) Conclusions: Signing a DNR order in the ED increased the ICU mortality rate among patients who had respiratory failure and needed ventilator support. It increased the risk of prolonged hospital LOS among survivors. Finally, signing a DNR order was associated with high medical fees among survivors.

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<p>Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan</p>

Cited by 3 publications

References 26 publications

Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage

Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage

Public Attitude towards Implementing DNAR and a Stance on Pediatric DNAR in Poland—A Prospective Survey Study

The Impact of Do-Not-Resuscitate Order in the Emergency Department on Respiratory Failure after ICU Admission

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