Related Experiment Video
Updated: Aug 2, 2026
Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Do-not-resuscitate orders in patients hospitalized with acute myocardial infarction: the Worcester Heart Attack Study
Elizabeth A Jackson1, Jorge L Yarzebski, Robert J Goldberg
1Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, and Meyers Primary Care Institute, Worcester, USA. elizabeth.jackson@umassmed.edu
Insights
Do-not-resuscitate (DNR) orders increased in acute myocardial infarction patients from 1991-1999. Patients with DNR orders received less cardiac treatment and had higher in-hospital mortality rates.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- Coronary heart disease is the leading cause of death in Americans.
- Limited data exist on do-not-resuscitate (DNR) order use in acutely ill cardiac patients.
- This study addresses the gap in understanding DNR orders in acute myocardial infarction (AMI).
Purpose of the Study:
- To describe the utilization of DNR orders in patients hospitalized with AMI.
- To examine treatment approaches in AMI patients with and without DNR orders.
- To analyze hospital outcomes for AMI patients with and without DNR orders.
Main Methods:
- A community-wide study of 4621 patients hospitalized with AMI.
- Data collected from metropolitan Worcester, Mass, area hospitals.
- Analysis of five 1-year periods between 1991 and 1999.
Main Results:
- DNR order use increased significantly from 16% in 1991 to 25% in 1999.
- Elderly, women, and patients with diabetes or stroke were more likely to have DNR orders.
- Patients with DNR orders received less cardiac medication and had higher mortality (44% vs 5%).
Conclusions:
- DNR order use in AMI patients has increased over the past decade.
- Significant differences in cardiac therapy and outcomes exist between patients with and without DNR orders.
- Further research is needed to characterize DNR order use in acute coronary disease.
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.
Related Concept Videos
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
01:14Myocarditis III: Medical Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management