End-of-life care in a cardiology department: have we improved?
BACKGROUND
End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate (DNR) order protocol.


RESULTS
Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet (Group A), a conventional DNR order (Group B) or the absence of any DNR order (Group C). The number of deaths was similar in both periods (n = 198 vs. n = 197). The rate of patients dying with a DNR order increased significantly (57.1% vs. 68.5%; P = 0.02). Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission (vs. 2.6% in the first period; P < 0.001). All patients in Group A with an implantable cardioverter defibrillator (ICD) had shock therapies deactivated (vs. 25.0% in the first period; P = 0.02).


CONCLUSIONS
The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, Madrid, Spain; Department of Cardiology, Hospital Universitario de Torrejón, Calle Mateo Inurria, Torrejón de Ardoz, Madrid, Spain; Universidad Francisco de Vitoria, Carretera Pozuelo a Majadahonda, Pozuelo de Alarcón, Madrid, Spain.
Juan
J
Ruiz-Garcia
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, Madrid, Spain; Department of Cardiology, Hospital Universitario de la Princesa, Calle de Diego de León, Madrid, Spain.
Pablo
P
Diez-Villanueva
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, Madrid, Spain.
Ana
A
Ayesta
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, Madrid, Spain.
Vanessa
V
Bruña
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, Madrid, Spain.
Lourdes M
LM
Figueiras-Graillet
Departmet of Cardiology, Hospital Universitario del Sureste, Ronda del Sur, Arganda del Rey, Madrid, Spain.
Laura
L
Gallego-Parra
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, Madrid, Spain; Universidad Complutense de Madrid, Av. Seneca, Madrid, Spain.
Francisco
F
Fernández-Avilés
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, Madrid, Spain; Universidad Complutense de Madrid, Av. Seneca, Madrid, Spain; Universidad Europea de Madrid, Urbanización El Bosque Calle Tajo, Villaviciosa de Odón, Madrid, Spain.
Manuel
M
Martínez-Sellés
Cardiology; Cardiopulmonary resuscitation; End-of-life; Palliative care