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DNR Code Status Is Not Associated with Under-Utilization of Inpatient Transthoracic Echocardiograms

Adarsh Katamreddy1, Aaron J Wengrofsky2, Weijia Li1

  • 1Internal Medicine, Jacobi Medical Center, Bronx, NY 10461, USA.

Journal of Cardiovascular Development and Disease
|September 26, 2021
PubMed

Insights

Do-not-resuscitate (DNR) status does not decrease the use of transthoracic echocardiography (TTE) in hospitalized patients. This study found DNR patients underwent TTE more often than full code patients, even after adjustments.

Area of Science:

  • Cardiology
  • Medical Ethics

Background:

  • Do-not-resuscitate (DNR) orders signify limitations on life-sustaining treatments like cardiopulmonary resuscitation.
  • The utilization of diagnostic tools, such as transthoracic echocardiography (TTE), in patients with DNR status is not well-established.
  • Understanding TTE use in DNR patients is crucial for aligning care with patient goals.

Purpose of the Study:

  • To evaluate the utilization of transthoracic echocardiography (TTE) in hospitalized patients with do-not-resuscitate (DNR) status.
  • To determine if DNR status is associated with reduced performance of inpatient TTE.

Main Methods:

  • Retrospective data analysis of 16,546 patient admissions.
  • Comparison of TTE utilization rates between patients with DNR status and full code status.
  • Univariate and multivariate logistic regression analyses adjusted for demographic and clinical factors.

Main Results:

  • A total of 4,370 (26.4%) patients underwent TTE during hospitalization.
  • TTE was performed in 37.4% of DNR patients compared to 25.7% of full code patients.
  • After multivariate adjustment, DNR status was not significantly associated with a decrease in inpatient TTE performance (OR 0.91; p=0.22).

Conclusions:

  • Do-not-resuscitate (DNR) status is not associated with a decrease in the performance of inpatient transthoracic echocardiography.
  • Hospitalized patients with DNR status may undergo TTE at similar or higher rates than those with full code status.
  • Clinical decisions regarding TTE should be based on patient needs, not solely on DNR status.

Keywords:
code statusdo not resuscitatetransthoracic echocardiogram

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