Coronary disease & ACSCohort study
Do-not-resuscitate (DNR) Status and Hospital Mortality Measures Postmyocardial Infarction: Differentiating Preventable From Unpreventable Deaths in CMS Data
- retrospective chart review
- national 100% Medicare Inpatient Standard Analytic File and Medicare Beneficiary Summary file
- single academic medical center (2019-2025)
Authors' conclusion
The validity of 30-day AMI mortality metrics may be undermined by their inclusion of high-acuity, end-of-life patients, which may disincentivize hospitals from delivering appropriate, patient-centered care. Removal of DNR or palliative cases from performance measures should be explored to better identify opportunities for reducing preventable deaths.
Study context
- Population
- Medicare acute myocardial infarction (AMI) encounters, stratified by DNR status and palliative care involvementtotal AMI encounters, 24 AMI mortalities at the single institution · Medicare AMI encounters 467,259 · AMI mortalities at the single institution 24
- Participants
- 467,259 participants
- Exposure
- 30-day AMI mortality rates stratified by DNR status (absent, present-on-admission, and postadmission) and palliative care involvement
- without DNRsn = 376,062reference
- present-on-admission DNRn = 60,719
- postadmission DNRn = 30,478
- palliative caren = 43,090
Main finding
As reported in the abstract
Thirty-day mortality by DNR status · 30 days
Observational data: associations, not effects.
Further findings
| Outcome | Hazard ratio (95% CI) | |
|---|---|---|
| Mortality hazard by DNR status — present-on-admission DNR vs without DNRs | 5.25 (5.17–5.33) | |
| Mortality hazard by DNR status — postadmission DNR vs without DNRs | 10.73 (10.55–10.91) | |
| 0.050.21520Hazard ratio (log scale) |
- Mortality among encounters with palliative care
- 76.9% · 33 151/43 090 of 43 090
- Mortality among encounters with palliative care — Encounters with palliative care
- 9.2% (43 090/467 259)
Population characteristics
- Age, mean (SD)
- 75.1 (10.5)
- Women
- 44%
Single-institution AMI mortalities (chart review)
- Of the 24 institutional AMI mortalities, had DNRs
- 71% (17/24)
- Of the 24 institutional AMI mortalities, met the unpreventable death criteria (Global Registry of Acute Coronary Events >190.5 or Palliative Performance Scale ≤40%)
- 33% (8/24)
Original publication
DNR Status and Hospital Mortality Measures Postmyocardial Infarction: Differentiating Preventable From Unpreventable Deaths in CMS Data. Circ Popul Health Outcomes. Published 30 July 2026. doi:10.1161/circoutcomes.125.013117
Summarised from the published abstract; every number is checked against it