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Cohort studyCirculation. Population health and outcomes · 2026

DNR Status and Hospital Mortality Measures Postmyocardial Infarction: Differentiating Preventable From Unpreventable Deaths in CMS Data.

Benjamin D Pollock, Annette M Danks, Razvan M Chirila … Jennifer B Cowart

Internal MedicineCohort study

Patients with postadmission do-not-resuscitate orders were associated with a higher hazard of 30-day mortality.

DNR Status and Hospital Mortality Measures Postmyocardial Infarction: Differentiating Preventable From Unpreventable Deaths in CMS Data.

Benjamin D Pollock … Jennifer B Cowart

Circulation. Population health and outcomes · 2026

Background

Publicly reported 30-day acute myocardial infarction (acute myocardial infarction) mortality rates are widely used to benchmark hospital performance.

Methods

We analyzed the national 100% Medicare Inpatient Standard Analytic File and Medicare Beneficiary Summary file to assess 30-day acute myocardial infarction mortality rates stratified by do-not-resuscitate status (absent, present-on-admission, and postadmission) and palliative care involvement.

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Results

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patients with do-not-resuscitate orders after admission had a greatly increased risk of death within 30 days

More results

Across n=467 259 total acute myocardial infarction encounters, mean (SD) age was 75.1 (10.5), and the population was 44% female.

Thirty-day mortality was 10.4% (39 112/376 062) among patients without DNRs, 43.1% (26 181/60 719) in those with present-on-admission do-not-resuscitate, and 72.1% (21 984/30 478) in those with postadmission do-not-resuscitate.

More results

Among 9.2% (43 090/467 259) of encounters with palliative care, there was a 76.9% mortality rate (33 151/43 090).

Among n=24 acute myocardial infarction mortalities at our institution, 71% (17/24) had DNRs, and 33% (8/24) met the unpreventable death criteria.

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Conclusion · 1 of 2

The validity of 30-day acute myocardial infarction 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.

Conclusion · 2 of 2

Removal of do-not-resuscitate or palliative cases from performance measures should be explored to better identify opportunities for reducing preventable deaths.

DNR Status and Hospital Mortality Measures Postmyocardial Infarction: Differentiating Preventable From Unpreventable Deaths in CMS Data.

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