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• W2500156939 abstract "Background: Accurate documentation of preferences for cardiopulmonary resuscitation at hospital admission is critical to ensure that patients receive resuscitation in accordance with their wishes. The accuracy of clinician-ordered resuscitation preferences in heart failure has not been examined. Therefore, we sought to identify and characterize inconsistencies in patient-reported and clinician-ordered resuscitation status in patients hospitalized with acute decompensated heart failure (ADHF). Methods: Southeastern Minnesota residents hospitalized with ADHF at Mayo Clinic hospitals in Rochester, MN were prospectively approached for recruitment into an observationalcohort study that included the administration of face-to-face questionnaires from January 2014 through February 2016. Patient-reported resuscitation status was assessed at enrollment using a validated question. Clinician-ordered resuscitation preferences at hospital admission were abstracted from the electronic medical record (EMR). Results: Of the 400 patients administered the questionnaire; 213 (53.3%) stated their resuscitation preference as full code, 166 (41.5%) do-not-resuscitate (DNR), and 21 (5.3%) were unsure. In comparison, clinician-ordered resuscitation status was full code in 263 (66.4%) patients, DNR in 133 (33.6%), and not documented in 4 (1.0%). Patient-reported and clinician-ordered resuscitation status were concordant in 80% of patients; the Cohen's kappa coefficient was 0.67, indicating good agreement. Of the 20% of patients with discordant resuscitation preferences; 5.6% elected full code by questionnaire and had a clinician order for DNR status, and 14.4% elected DNR by questionnaire but had a full code clinician order. Compared to those who were full code by both questionnaire and clinician order (n = 190), patients with discordant resuscitation status (n = 75) were older (P = .010), less often had peripheral vascular disease (P = .004), had a trend toward longer hospital length of stay (P = .068), and less often discharged to home (P = .006). Compared to those who were DNR by questionnaire and clinician order (n = 110), patients with discordant resuscitation status were younger (P < .001), more often married (P = .001), had better health literacy (P = .012), lower EF (P = .022), less peripheral vascular disease (P = .011), longer length of stay (P = .033), and less often had a healthcare power of attorney or living will (P = .012). Conclusions: Patient-reported and clinician-ordered resuscitation preferences were discordant in 20% of patients hospitalized with ADHF. The majority of inconsistencies occurred in patients that stated a desire to be DNR, but had a full code clinician order in the EMR. The underlying etiology of these inconsistencies may reflect factors such as patient indecisiveness or patient-clinician miscommunication, and requires further exploration." @default.
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• W2500156939 date "2016-08-01" @default.
• W2500156939 modified "2023-10-14" @default.
• W2500156939 title "Discordance of Patient-Reported and Clinician-Ordered Resuscitation Status in Patients Hospitalized with Acute Decompensated Heart Failure" @default.
• W2500156939 doi "https://doi.org/10.1016/j.cardfail.2016.06.078" @default.
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