Satoshi Honda1, Toshiyuki Nagai2, Yasuo Sugano3, Atsushi Okada3, Yasuhide Asaumi3, Takeshi Aiba3, Teruo Noguchi3, Kengo Kusano3, Hisao Ogawa3, Satoshi Yasuda1, Toshihisa Anzai3. 1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduated School of Medical Science, Kumamoto University, Kumamoto, Japan. 2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: nagai@ncvc.go.jp. 3. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Abstract
BACKGROUND: Delirium is a serious syndrome in critically ill patients. However, the prognostic impact of delirium and its determinants in acute heart failure (AHF) patients have not been fully elucidated. METHODS: We examined 611 AHF patients who were admitted to our institution. Delirium was diagnosed based on the Intensive Care Delirium Screening Checklist (ICDSC). RESULTS: Delirium developed in 139 patients (23%) during hospitalization. Patients with delirium had higher incidence of non-cardiovascular death (p=0.046) and worsening heart failure (p<0.001) during hospitalization. Among patients who survived at discharge, the incidence of all-cause death, cardiovascular death and non-cardiovascular death after discharge were significantly higher in patients with delirium than those without (log-rank; p<0.001, p=0.001, p<0.001, respectively) during a median follow-up period of 335days. In multivariable model, the development of delirium was an independent determinant of worsening heart failure during hospitalization (OR: 2.44, 95% CI: 1.27-4.63) and all-cause death after discharge (HR: 2.38, 95% CI: 1.30-4.35). Furthermore, multivariate analysis indicated that history of cerebrovascular disease (OR: 2.13, 95% CI: 1.36-3.35), age (OR: 1.43, 95% CI: 1.15-1.80), log BNP (OR: 1.39, 95% CI: 1.09-1.79), serum albumin (OR: 0.84, 95% CI: 0.76-0.93) and blood glucose levels (OR: 1.03, 95% CI: 1.00-1.06) were independent determinants of delirium. CONCLUSION: In patients with AHF, the development of delirium was associated with poor clinical outcomes, suggesting the importance of early screening and careful monitoring of delirium in such patients.
BACKGROUND:Delirium is a serious syndrome in critically illpatients. However, the prognostic impact of delirium and its determinants in acute heart failure (AHF) patients have not been fully elucidated. METHODS: We examined 611 AHF patients who were admitted to our institution. Delirium was diagnosed based on the Intensive Care Delirium Screening Checklist (ICDSC). RESULTS:Delirium developed in 139 patients (23%) during hospitalization. Patients with delirium had higher incidence of non-cardiovascular death (p=0.046) and worsening heart failure (p<0.001) during hospitalization. Among patients who survived at discharge, the incidence of all-cause death, cardiovascular death and non-cardiovascular death after discharge were significantly higher in patients with delirium than those without (log-rank; p<0.001, p=0.001, p<0.001, respectively) during a median follow-up period of 335days. In multivariable model, the development of delirium was an independent determinant of worsening heart failure during hospitalization (OR: 2.44, 95% CI: 1.27-4.63) and all-cause death after discharge (HR: 2.38, 95% CI: 1.30-4.35). Furthermore, multivariate analysis indicated that history of cerebrovascular disease (OR: 2.13, 95% CI: 1.36-3.35), age (OR: 1.43, 95% CI: 1.15-1.80), log BNP (OR: 1.39, 95% CI: 1.09-1.79), serum albumin (OR: 0.84, 95% CI: 0.76-0.93) and blood glucose levels (OR: 1.03, 95% CI: 1.00-1.06) were independent determinants of delirium. CONCLUSION: In patients with AHF, the development of delirium was associated with poor clinical outcomes, suggesting the importance of early screening and careful monitoring of delirium in such patients.
Authors: Eiran Z Gorodeski; Parag Goyal; Scott L Hummel; Ashok Krishnaswami; Sarah J Goodlin; Linda L Hart; Daniel E Forman; Nanette K Wenger; James N Kirkpatrick; Karen P Alexander Journal: J Am Coll Cardiol Date: 2018-05-01 Impact factor: 24.094
Authors: Katrina Kalantar; Sara C LaHue; Joseph L DeRisi; Hannah A Sample; Caitlin A Contag; Scott A Josephson; Michael R Wilson; Vanja C Douglas Journal: J Geriatr Psychiatry Neurol Date: 2018-07-10 Impact factor: 2.680
Authors: Khalil Ibrahim; Cian P McCarthy; Killian J McCarthy; Charles H Brown; Dale M Needham; James L Januzzi; John W McEvoy Journal: J Am Heart Assoc Date: 2018-02-16 Impact factor: 5.501
Authors: Toshiyuki Nagai; Varun Sundaram; Kieran Rothnie; Jennifer Kathleen Quint; Ahmad Shoaib; Yasuyuki Shiraishi; Shun Kohsaka; Susan Piper; Theresa A McDonagh; Suzanna Marie C Hardman; Ayumi Goda; Atsushi Mizuno; Takashi Kohno; Alan S Rigby; Tsutomu Yoshikawa; Andrew L Clark; Toshihisa Anzai; John G F Cleland Journal: Open Heart Date: 2018-09-11