Differences and Trends in DNR Among California Inpatients With Heart Failure

• Do-not-resuscitate (DNR) rates among patients admitted for heart failure in California are slowly rising.
• Race and gender differences exist in DNR election among these patients.
• DNR rates vary by hospital funding and teaching status.
• As expected, DNR election is associated with greater mortality and fewer procedures.

BackgroundDo-not-resuscitate (DNR) orders reflect an important means of respecting patient autonomy while minimizing the risk of nonbeneficial interventions. We sought to clarify trends and differences in rates of DNR orders for patients hospitalized with heart failure.MethodsWe used statewide data from California's Healthcare Cost and Utilization dataset (2007–2010) to determine trends in DNR orders within 24 hours of admission for patients with a primary discharge diagnosis of heart failure.ResultsAmong 347,541 hospitalizations for heart failure, the rate of DNR order within 24 hours increased from 10.4% in 2007 to 11.3% in 2010 (P < .0001). After adjustment, DNR status correlated with older age, female gender, white race, frequent comorbidities (Charlson Score), and residence in higher income area (P < .0001). DNR use was more likely in hospitals with public or nonprofit financing or medical school affiliation, but not being a member of the Council on Teaching Hospitals (all P < .001).ConclusionDNR order use among inpatients with heart failure is low but increasing slowly and varies by patient demographics and hospital characteristics.