49 Do patients who die with multiple long-term conditions have DNACPR decisions recorded?

<h3>Background</h3> Patients’ preferences for cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest should be elicited in advance of acute crises. When ‘do not attempt CPR’ (DNACPR) decisions are recorded in healthcare records, they can prevent futile, unwanted resuscitation for patients who are dying. However, discussion may not take place, if end-of-life is not recognised. This may be a particular challenge for people who are dying with multiple long-term conditions (MLTC). In this study, we aimed to identify the number of patients with MLTC who had codes recorded for DNACPR in electronic healthcare records from general practice (GP) and determine if patients with certain diseases were more or less likely to have recorded decisions. <h3>Methods</h3> We used the Clinical Practice Research Datalink (CPRD), a representative, longitudinal dataset of 21,198,382 UK GP records. Patients were included in our study if they were aged over the age of 50 years, had at least 365 days of records, MLTC (at least 2 conditions from the Charlson Comorbidity Index) and a date of death in 2023. Records were examined for DNACPR codes. Logistic regression was used to compare the likelihood of having DNACPR codes recorded, by different long-term conditions. <h3>Results</h3> Of the patients eligible for inclusion, 33% had codes for DNACPR decisions recorded. People who died with metastatic cancer (OR 4.66, CI 4.16,5.21) were most likely to have codes for DNACPR. Patients who died with pulmonary disease were the least likely (OR 0.92, CI 0.87, 0.99). Having complex MLTC-M (four or more conditions) (OR 1.06, CI 0.99, 1.14), did not confer an increased likelihood of DNACPR code. <h3>Conclusions</h3> Very few patients with MLTC who were in the last year of their life, had codes for DNACPR decisions on their GP records. Having a cancer diagnosis within MLTC appears to increase recognition of end-of-life.