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Hi, everyone.

This is John Mandrola from the heart.org medscape cardiology, and this is this week in cardiology for February 27th,

2026. This week, I had a superb listener note on CPR and DNR orders, persons versus doctors' preferences

for statins, more on GLP1 drugs, another left atrial appendage closure story, and some closing

cautionary notes on PFAAF ablation. First, listener feedback. I did not think I would receive

any feedback on my coverage of the JAMA letter on unilateral DNR orders from last week.

I was struck by the fact that JAMA published such clear thinking on the tension of seeking

and writing DNR orders, but indeed I received a superb piece of feedback on the tension of getting

DNR orders, and the letter came from New Zealand, no less. To recap about the story, very briefly,

in an ideal world, patients who have life-limiting disease or diseases recognize it and do not

wish to have CPR in the event of hemodynamic collapse. There is alignment between patient

preferences and best medical care. Yet there is not always such alignment.

In some cases, patients are so ill that they cannot meaningfully participate in complex decision-making.

So, a unilateral DNR is then placed. So the translation here is that the doctor treats CPR as a non-beneficial intervention

and states that we will not do it, like we won't do an AVR or an aphib ablation.

Now, this can be extremely complex when such an order conflicts with the family's wishes.

One of the points made in the original JAMA piece was that DNR orders were often not clearly written enough to know who or how the decision came to be made.

Well, New Zealand cardiologist and advanced care planning advocate, Dr. Tammy Pegg, wrote to me to say she agreed with my assertion that CPR should be viewed as another

medical intervention, and therefore its benefit, risk, lies with the clinical team, not so much the

...