A study published in the Journal of the American Geriatrics Society on Aug. 9 found “marked heterogeneity” in the management of periprocedural code status across TAVR programs, specifically concerning the timeline for reinstating do not resuscitate (DNR) status.

Gwen M. Bernacki, MD, et al., used data from the STS/ACC TVT Registry to evaluate differences in program size, patient characteristics, risk status and outcomes. The study authors also conducted interviews with TAVR coordinators from 71% of invited programs in California and Washington. Through these interviews, researchers gained insights into the programs’ periprocedural code status policies and how clinicians work to accommodate their patients’ goals of care.

The study found that although 96% of TAVR programs addressed periprocedural code status, only 26% of the programs interviewed had official policies. While most programs rescinded DNR status until after TAVR, the timeline for reestablishing DNR status varied (<48 h post TAVR for 38%; 48 h to discharge for 44%; >30 days post discharge for 18%).

Researchers noted a difference in rationale between programs that rescinded DNR status temporarily vs. those that maintained it: “Six programs maintaining DNR status recognized TAVR as a palliative procedure. Among programs categorically reversing patients’ DNR status, the rationale for differing lengths of time to reinstatement reflect divergent views on accountability and reporting requirements.”

Bernacki, et al., conclude that their research demonstrates a need for standardization of DNR decisions before, during and after TAVR to ensure consistent care and alignment with the patient’s health goals.

“This paper addresses a very important question about periprocedural code status for TAVR patients and highlights the need for a standard policy for patients undergoing TAVR that respects their wishes and goals,” says Eugene Yang, MD, FACC, a study author and chair of ACC’s Prevention of Cardiovascular Disease Member Section. “It also represents a great collaboration between ACC State Chapters and Member Sections, demonstrating how these efforts can lead to important scientific contributions. I applaud the ACC for recognizing and funding this research. ACC Chapters and Sections are important incubators to identify clinically relevant topics that require scientific exploration.”

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention

Keywords: Surgeons, Incubators, Geriatrics, California, Social Responsibility, Reference Standards, Policy, Patient Care Planning, Registries, Washington, Respect, Patient Discharge, Goals, Aftercare, Cardiovascular Diseases, Resuscitation Orders, Transcatheter Aortic Valve Replacement, National Cardiovascular Data Registries, STS/ACC TVT Registry

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