Do-not-resuscitate orders and palliative care in patients who die in cardiology departments. What can be improved?

The use of do-not-resuscitate orders and palliative care was studied in 198 consecutive deaths of patients with heart disease that occurred in our department. In 113 (57%), it was decided not to resuscitate. The decision took into account the patient's medical history in 102 patients (90.3%) and departmental medical charts in 74 (65.5%). In total, 5 patients (4.4%) and 95 patients' families (84.1%) were informed. Little palliative treatment was used in patients with do-not-resuscitate orders: 56 (49.6%) received morphine and 5 (4.4%), spiritual support. However, prior to issuing the do-not-resuscitate order, these patients frequently received aggressive and expensive treatment such as orotracheal intubation in 49 (43.4%), coronary angiography in 27 (23.9%), inotropic drugs in 55 (48.7%) and intra-aortic balloon counterpulsation in 15 (13.3%). In conclusion, almost three-fifths of patients who died in a cardiology department had a do-not-resuscitate order. The decision to issue the order was frequently taken after administering aggressive treatment and little palliative care was provided afterward.