From the Section of Cardiovascular Medicine, Department of Medicine and
the Section of Chronic Disease Epidemiology, Department of Epidemiology and
Public Health, Yale School of Medicine and the Yale-New Haven Hospital Center
for Outcomes Research and Evaluation, New Haven, Conn (H.M.K.); the Division
of General Medicine and Primary Care, Beth Israel Hospital, Boston, Mass
(R.S.P., M.B.H., R.B.D.); the Center for Gerontology and Health Care Research,
Brown University, Providence, RI (J.M.T.); the UCLA School of Medicine, UCLA
Medical Center, Los Angeles, Calif (P.B.); the Marshfield Medical Research
Foundation/Marshfield Clinic, Marshfield, Wis (S.K.B., H.V.); the Duke
University Medical Center, Durham, NC (R.M.C., L.H.M.); Case Western Reserve
University, MetroHealth Medical Center, Cleveland, Ohio (A.F.C.); George
Washington University Medical Center, Washington, DC (J.L.); and the
Department of Medicine, University of California, San Francisco, Calif (L.G.).
Correspondence to Harlan M. Krumholz, MD, Yale School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025. E-mail harlan.krumholz{at}yale.edu
Background—We sought to describe the
resuscitation preferences of patients hospitalized with an exacerbation
of severe congestive heart failure, perceptions of those preferences by
their physicians, and the stability of the preferences.
Methods and Results—Of 936 patients in this study, 215 (23%)
explicitly stated that they did not want to be resuscitated.
Significant correlates of not wanting to be resuscitated included older
age, perception of a worse prognosis, poorer functional status, and
higher income. The physician's perception of the patient's preference
disagreed with the patient's actual preference in 24% of the cases
overall. Only 25% of the patients reported discussing resuscitation
preferences with their physician, but discussion of preferences was not
significantly associated with higher agreement between the patient and
physician. Of the 600 patients who responded to the resuscitation
question again 2 months later, 19% had changed their preferences,
including 14% of those who initially wanted resuscitation (69 of 480)
and 40% of those who initially did not (48 of 120). The physician's
perception of the patient's hospital resuscitation preference was
correct for 84% of patients who had a stable preference and 68% of
those who did not.
Conclusions—Almost one quarter of patients hospitalized with
severe heart failure expressed a preference not to be resuscitated. The
physician's perception of the patient's preference was not accurate
in about one quarter of the cases, but communication was not associated
with greater agreement between the patient and the physician. A
substantial proportion of patients who did not want to be resuscitated
changed their minds within 2 months of discharge.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Resuscitation Preferences Among Patients With Severe Congestive Heart Failure
Results From the SUPPORT Project
Key Words: resuscitation • patients • heart failure
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