Cost-Savings of Do Not Resuscitate Orders Among Elderly Patients With Heart Failure in the United States

Abstract

Do-not-resuscitate (DNR) orders should preclude the use of cardiopulmonary resuscitation and may be associated with patient outcomes for patients hospitalized with heart failure (HF). This study examined the association between DNR and costs, mortality, and length of stay. The study cohort was a national sample of 700 922 hospital admissions of patients aged >65 with a primary diagnosis of HF. Elderly HF patients who died with a DNR had cost-savings of $5640 (P < 0.001). Patients with a DNR order were 8.9% points more likely to die before discharge than patients without (P < 0.001), and patients who died with a DNR had a significantly shorter hospital stay by 1.51 days (P < 0.001). DNR orders among elderly patients with HF are associated with cost-savings, as well as a higher mortality and shorter length of stay. In addition to primary benefits, advance care planning may aid in containing costs of care at end of life for HF.

Do-not-attempt resuscitation policy reduced in-hospital cardiac arrest rate and the cost of care in a developing country

“…Placing a patient on a DNR does not equate to denying other life-sustaining treatments such as oxygen, intravenous fluids and antibiotics [ 25 , 26 ]. Instead, it is an integral part of the advance care plan, which includes a living will, surrogate decision-making, and treatment escalation policy [ 27 , 28 ]. In this study, the DNR patients had a ceiling of care limited to the ward level and were not admitted to the ICU.…”

“…Patients with DNR have reduced hospital length of stay, increased mortality and reduced ICU costs [ 14 , 28 , 31 ]. This study shows that an additional 493 patients would have had CPR without a DNR policy.…”