Do-not-resuscitate orders and readmission among elderly patients with heart failure in Pennsylvania: An observational study, 2011 - 2014

Background: Readmissions for patients with heart failure (HF) continues to be a target of value-based purchasing initiatives. Do-not-resuscitate (DNR) orders—one part of advance care planning (ACP)—have been shown to be related to other patient outcomes but has not been explored as a risk factor for HF readmission. Objectives: Examine the association between DNR and 30-day readmissions among elderly patients with HF admitted to hospitals in Pennsylvania. Methods: Data included hospital discharges from 2011 to 2014 of patients 65+ years with a primary diagnosis of HF. Logistic regression was used to model the relationship between DNR and 30-day readmission. Results: Among 107,806 patients, 20.9% were readmitted within 30 days. After controlling for covariates, patients with HF who had a DNR were less likely to be readmitted to the hospital (OR=0.85, 95% CI: 0.80–0.91, p<0.001). Conclusions: Documentation of a DNR may inform efforts to reduce readmissions among elderly patients with HF.