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.