DNR Code Status Is Not Associated with Under-Utilization of Inpatient Transthoracic Echocardiograms
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
4.1. Predictors of Inpatient Transthoracic Echocardiogram Performance
4.2. Strengths and Limitations
4.3. Clinical Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Stevenson, E.K.; Mehter, H.M.; Walkey, A.J.; Wiener, R.S. Association between Do Not Resuscitate/Do Not Intubate Status and Resident Physician Decision-making. A National Survey. Ann. Am. Thorac. Soc. 2017, 14, 536–542. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hillis, G.S.; Bloomfield, P. Basic transthoracic echocardiography. BMJ 2005, 330, 1432–1436. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Qaseem, A.; Alguire, P.; Dallas, P.; Feinberg, L.E.; Fitzgerald, F.T.; Horwitch, C.; Humphrey, L.; Leblond, R.; Moyer, D.; Wiese, J.G.; et al. Appropriate Use of Screening and Diagnostic Tests to Foster High-Value, Cost-Conscious Care. Ann. Intern. Med. 2012, 156, 147–149. [Google Scholar] [CrossRef] [PubMed]
- Elixhauser, A.; Steiner, C.; Harris, D.R.; Coffey, R.M. Comorbidity Measures for Use with Administrative Data. Med. Care 1998, 36, 8–27. [Google Scholar] [CrossRef] [PubMed]
- Medina-Inojosa, J.; Jean, N.; Cortes-Bergoderi, M.; Lopez-Jimenez, F. The Hispanic Paradox in Cardiovascular Disease and Total Mortality. Prog. Cardiovasc. Dis. 2014, 57, 286–292. [Google Scholar] [CrossRef] [PubMed]
n | Overall 16,546 | Full Code 15,492 | DNR 1054 | p-Value |
---|---|---|---|---|
Age (years), median [Q1, Q3] | 61.0 [47.0, 74.0] | 60.0 [45.0, 72.0] | 80.0 [69.0, 88.5] | <0.001 |
Male, n (%) | 7014 (42.4) | 6569 (42.4) | 445 (42.2) | 0.933 |
Race | ||||
African American, n (%) | 5637 (34.1) | 5304 (34.2) | 333 (31.6) | <0.001 |
Caucasian, n (%) | 2238 (13.5) | 1996 (12.9) | 242 (23.0) | |
Hispanic, n (%) | 6734 (40.7) | 6376 (41.2) | 358 (34.0) | |
Other, n (%) | 1937 (11.7) | 1816 (11.7) | 121 (11.5) | |
Comorbidity | ||||
Stroke, n (%) | 1062 (6.4) | 945 (6.1) | 117 (11.1) | <0.001 |
Myocardial infarction, n (%) | 1350 (8.2) | 1211 (7.8) | 139 (13.2) | <0.001 |
Peripheral artery disease, n (%) | 565 (3.4) | 516 (3.3) | 49 (4.6) | 0.028 |
Heart failure, n (%) | 5672 (34.3) | 5280 (34.1) | 392 (37.2) | <0.001 |
Diabetes mellitus, n (%) | 5672 (34.3) | 5280 (34.1) | 392 (37.2) | 0.043 |
Liver disease, n (%) | 259 (1.6) | 238 (1.5) | 21 (2.0) | 0.305 |
Hypertension, n (%) | 7970 (48.2) | 7435 (48.0) | 535 (50.8) | 0.088 |
Malignancy, n (%) | 1687 (10.2) | 1502 (9.7) | 185 (17.6) | <0.001 |
Kidney, n (%) | 4223 (25.5) | 3791 (24.5) | 432 (41.0) | <0.001 |
Elixhauser comorbidity index, median [Q1, Q3] | 4.0 [0.0, 14.0] | 4.0 [0.0, 14.0] | 4.0 [0.0, 14.0] | 0.688 |
Transthoracic echocardiogram, n (%) | 4370 (26.4) | 3976 (25.7) | 394 (37.4) | <0.001 |
Univariate Models | Multivariate Model i | |||
---|---|---|---|---|
OR (95% CI) g | p-Value h | OR (95% CI) g | p-Value h | |
Age a | 1.02 (1.02–1.02) | < 0.01 | 1.02 (1.02–1.02) | <0.01 |
Sex b | 1.36 (1.27–1.46) | < 0.01 | 1.29 (1.19–1.39) | <0.01 |
Race (Caucasian) c | 1.10 (0.99–1.23) | 0.06 | 0.96 (0.86–1.08) | 0.51 |
Race (Hispanic) d | 0.79 (0.73–0.85) | < 0.01 | 0.82 (0.76–0.89) | <0.01 |
Race (Other) e | 0.78 (0.69–0.87) | < 0.01 | 0.88 (0.78–0.99) | 0.04 |
Comorbidities f | ||||
Stroke | 2.73 (2.40–3.09) | < 0.01 | 2.19 (1.92–2.50) | <0.01 |
Myocardial infarction | 2.78 (2.48–3.11) | < 0.01 | 1.81 (1.60–2.05) | <0.01 |
Peripheral artery disease | 1.27 (1.06–1.52) | < 0.01 | 0.64 (0.52–0.78) | <0.01 |
Heart failure | 3.29 (3.04–3.55) | < 0.01 | 2.51 (2.32–2.75) | <0.01 |
Diabetes mellitus | 1.66 (1.54–1.78) | < 0.01 | 1.14 (1.06–1.24) | <0.01 |
Hypertension | 0.96 (0.90–1.03) | 0.34 | ||
Liver disease | 1.12 (0.85–1.46) | 0.31 | ||
Malignancy | 0.83 (0.73–0.93) | < 0.01 | 0.70 (0.62–0.79) | <0.01 |
Kidney disease | 1.57 (1.45–1.69) | < 0.01 | 0.87 (0.80–0.95) | <0.01 |
Elixhauser comorbidity score | 1.00 (0.99–1.00) | 0.92 | ||
Full code j | 0.57 (0.51–0.66) | < 0.01 | 0.91 (0.79–1.05) | 0.22 |
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Katamreddy, A.; Wengrofsky, A.J.; Li, W.; Taub, C.C. DNR Code Status Is Not Associated with Under-Utilization of Inpatient Transthoracic Echocardiograms. J. Cardiovasc. Dev. Dis. 2021, 8, 112. https://doi.org/10.3390/jcdd8090112
Katamreddy A, Wengrofsky AJ, Li W, Taub CC. DNR Code Status Is Not Associated with Under-Utilization of Inpatient Transthoracic Echocardiograms. Journal of Cardiovascular Development and Disease. 2021; 8(9):112. https://doi.org/10.3390/jcdd8090112
Chicago/Turabian StyleKatamreddy, Adarsh, Aaron J. Wengrofsky, Weijia Li, and Cynthia C. Taub. 2021. "DNR Code Status Is Not Associated with Under-Utilization of Inpatient Transthoracic Echocardiograms" Journal of Cardiovascular Development and Disease 8, no. 9: 112. https://doi.org/10.3390/jcdd8090112