Francisco J Noriega1, María T Vidán2, Elísabet Sánchez3, Andrea Díaz4, José A Serra-Rexach5, Francisco Fernández-Avilés6, Héctor Bueno7. 1. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 2. Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación IiSGM; Universidad Complutense de Madrid, Madrid, Spain. Electronic address: mvidan.hgugm@salud.madrid.org. 3. Department of Geriatric Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain. 4. Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 5. Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación IiSGM; Universidad Complutense de Madrid, Madrid, Spain. 6. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación IiSGM; Universidad Complutense de Madrid, Madrid, Spain. 7. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de investigación i+12 and Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
Abstract
BACKGROUND: Delirium is one of the most frequent complications of hospitalization in elderly patients. Its influence on prognosis in patients admitted for acute cardiac diseases is not well known. The objective of this study is to assess the incidence of delirium and its impact on clinical and functional outcomes in older patients hospitalized for acute cardiac diseases. METHODS: We prospectively analyzed 203 patients aged 75years or older admitted to a cardiology unit. Delirium was diagnosed with the Confusion Assessment Method. Logistic regression analysis was used to assess independent predictors of in-hospital delirium and to examine the independent risk of mortality, readmission, functional decline, and need for new help at discharge, at 1month and 12months associated with the development of delirium, after adjusting for age, comorbidity, and initial diagnosis. RESULTS: The incidence of delirium was 17.2%. Patients with delirium were older (83±5 vs 81±5years, P=.016) and showed a higher prevalence of major geriatric syndromes (82.9% vs 54.5%, P=.002). Aggressive ventilation modes, urinary catheters, prolonged fluid therapy, night treatments, longer immobilization, and physical restrain were associated with the incidence of delirium. Patients with delirium presented longer stays (8.9±6.2 vs 6.5±4.0days, P=.016) and a greater adjusted risk of functional decline at discharge (odds ratio 2.94, 95% CI 1.10-7.86, P=.032) and of 12-month mortality (odds ratio 4.20, 95% CI 1.81-9.74, P=.001). CONCLUSION: Delirium is a common preventable complication in older patients with acute cardiac diseases. It is associated with poorer in-hospital functional and clinical outcomes, and increased postdischarge mortality.
BACKGROUND:Delirium is one of the most frequent complications of hospitalization in elderly patients. Its influence on prognosis in patients admitted for acute cardiac diseases is not well known. The objective of this study is to assess the incidence of delirium and its impact on clinical and functional outcomes in older patients hospitalized for acute cardiac diseases. METHODS: We prospectively analyzed 203 patients aged 75years or older admitted to a cardiology unit. Delirium was diagnosed with the Confusion Assessment Method. Logistic regression analysis was used to assess independent predictors of in-hospital delirium and to examine the independent risk of mortality, readmission, functional decline, and need for new help at discharge, at 1month and 12months associated with the development of delirium, after adjusting for age, comorbidity, and initial diagnosis. RESULTS: The incidence of delirium was 17.2%. Patients with delirium were older (83±5 vs 81±5years, P=.016) and showed a higher prevalence of major geriatric syndromes (82.9% vs 54.5%, P=.002). Aggressive ventilation modes, urinary catheters, prolonged fluid therapy, night treatments, longer immobilization, and physical restrain were associated with the incidence of delirium. Patients with delirium presented longer stays (8.9±6.2 vs 6.5±4.0days, P=.016) and a greater adjusted risk of functional decline at discharge (odds ratio 2.94, 95% CI 1.10-7.86, P=.032) and of 12-month mortality (odds ratio 4.20, 95% CI 1.81-9.74, P=.001). CONCLUSION:Delirium is a common preventable complication in older patients with acute cardiac diseases. It is associated with poorer in-hospital functional and clinical outcomes, and increased postdischarge mortality.
Authors: Kimberly F Rengel; Christina J Hayhurst; James C Jackson; Christina S Boncyk; Mayur B Patel; Nathan E Brummel; Yaping Shi; Matthew S Shotwell; E Wesley Ely; Pratik P Pandharipande; Christopher G Hughes Journal: Crit Care Med Date: 2021-05-01 Impact factor: 7.598
Authors: Leslie Sp Eide; Anette H Ranhoff; Sandra Lauck; Bengt Fridlund; Rune Haaverstad; Karl Ove Hufthammer; Karel K J Kuiper; Jan Erik Nordrehaug; Tone Merete Norekvål Journal: BMJ Open Date: 2018-11-01 Impact factor: 2.692