Delirium in cardiac patients | European Heart Journal

We found that delirium was a very frequent condition among the elderly with acute cardiac diseases. The population consisted of 726 patients ... SkiptoMainContent Advertisement SearchMenu AccountMenu Menu SignIn Register NavbarSearchFilter ThisissueAllEuropeanHeartJournal AllESCFamilyAllJournals MobileMicrositeSearchTerm Search SignIn Register Issues MoreContent AdvanceArticles Editor'sChoice Guidelines CardioPulse WeeklyJournalScan IntheNews Podcasts Webinars CardioImageBank ESCJournalsApp Submit AuthorGuidelines SubmissionSite OpenAccessOptions AuthorResources Self-ArchivingPolicy Read&Publish Purchase Advertise AdvertisingandCorporateServices Advertising ReprintsandePrints SponsoredSupplements JournalsCareerNetwork About AboutEuropeanHeartJournal EditorialBoard AbouttheEuropeanSocietyofCardiology ESCMembership Alerts DevelopingCountriesInitiative DispatchDates TermsandConditions Issues MoreContent AdvanceArticles Editor'sChoice Guidelines CardioPulse WeeklyJournalScan IntheNews Podcasts Webinars CardioImageBank ESCJournalsApp Submit AuthorGuidelines SubmissionSite OpenAccessOptions AuthorResources Self-ArchivingPolicy Read&Publish Purchase Advertise AdvertisingandCorporateServices Advertising ReprintsandePrints SponsoredSupplements JournalsCareerNetwork About AboutEuropeanHeartJournal EditorialBoard AbouttheEuropeanSocietyofCardiology ESCMembership Alerts DevelopingCountriesInitiative DispatchDates TermsandConditions Close searchfilter Thisissue AllEuropeanHeartJournal AllESCFamily AllJournals searchinput Search AdvancedSearch SearchMenu ArticleNavigation Closemobilesearchnavigation ArticleNavigation Volume38 Issue29 01August2017 ArticleContents ArticleNavigation ArticleNavigation Deliriumincardiacpatients SimoneGrotti, SimoneGrotti *DivisionofCardiology,Morgagni-PierantoniHospital,ViaCarloForlanini34,47121,Forlꩉtaly,Tel:00390543738151,Fax:00390543738640 Searchforotherworksbythisauthoron: OxfordAcademic PubMed GoogleScholar GiovanniFalsini GiovanniFalsini *CardiovascularDiseasesSanDonatoHospitalArezzo,Italy *[email protected] Searchforotherworksbythisauthoron: OxfordAcademic PubMed GoogleScholar EuropeanHeartJournal,Volume38,Issue29,01August2017,Page2244,https://doi.org/10.1093/eurheartj/ehx380 Published: 01August2017 PDF SplitView Views Articlecontents Figures&tables Video Audio SupplementaryData Cite Cite SimoneGrotti,GiovanniFalsini,Deliriumincardiacpatients,EuropeanHeartJournal,Volume38,Issue29,01August2017,Page2244,https://doi.org/10.1093/eurheartj/ehx380 SelectFormat Selectformat .ris(Mendeley,Papers,Zotero) .enw(EndNote) .bibtex(BibTex) .txt(Medlars,RefWorks) Downloadcitation Close PermissionsIcon Permissions Share Email Twitter Facebook More NavbarSearchFilter ThisissueAllEuropeanHeartJournal AllESCFamilyAllJournals MobileMicrositeSearchTerm Search SignIn Register Close searchfilter Thisissue AllEuropeanHeartJournal AllESCFamily AllJournals searchinput Search AdvancedSearch SearchMenu Theclinicalimpactofdeliriuminthecoronarycareunitwhereitisassociatedwitha5-foldincreasedmortality Deliriumisaclinicalsyndromecausedbyadisturbanceinthenormalfunctioningofthebrain.Deliriouspatientspresentwithareducedawarenessofandresponsivenesstotheenvironment,whichmaybemanifestedasdisorientation,incoherence,andmemorydisturbance.Thisconditionaffectsatleast1in10hospitalizedpatientsandismorecommonintheelderly.Amonghospitalizedpatients,thoseadmittedtoanintensivecareunitaremorelikelytodevelopsuchaconditionthaninthegeneralpopulation.Innon-cardiovascularcriticalcare,increasingawarenessofdeliriuminthelastdecadehasbeenfollowedbythedevelopmentofmethodsforearlydetectionandriskfactorassessmentandhasledtothecreationoftargetedinterventionstrategiesaimedatlimitingitsconsequences.Giventheageingofthepopulationandthegrowingnumberofinterventionalproceduresamongtheelderly,eventhemoderncardiologistshouldbeawareofthiscomplication.However,littleisknownaboutdeliriumanditssignificanceinthecardiacICU(CICU).TheDELIRIUMCORDISstudywasaimedtoprospectivelyinvestigatebothincidenceandclinicalimpactofthisconditiononindividualswithacutecardiacdiseases.Weevaluatedallthepatientsaged ≥65 yearsadmittedtothecardiacintensivecareunitsofourinstitutionsduringaperiodof15 months.Ofnote,onlynon-intubatedpatientswereenrolled.Validatedscoresystemsandquestionnaireswereusedtodetectanddiagnosethepresenceofdeliriumatadmissionorduringthehospitalstay.Deliriouspatientswerecloselyfollowedbynursingandmedicalstaff,thatappliedaflowchartfortreatment,includingmeasurestoremovetreatablemedicalfactors,orpharmacologicalstrategywhenneeded.A6-monthtelephonevisitwasthenperformedtorecordadverseevents.Wefoundthatdeliriumwasaveryfrequentconditionamongtheelderlywithacutecardiacdiseases.Thepopulationconsistedof726patientswithameanageof79 years,and15%ofthemshoweddelirium(atadmissionorduringthehospitalstay).Interestingly,overhalfofpatients85 yearsorolderweredelirious.Patientswithdeliriumshowedaworseprognosiswithafive-foldincreaseinin-hospitaland30-daymortality,andatwo-foldincreasein6-monthmortality.Deliriumshowedtobeastrongandindependentpredictorofbothshort-andlong-termmortality,andwasalsoassociatedwithlongerhospitalstayandmorefrequentre-hospitalizationsduringfollow-up.Nosignificantassociationwasfoundbetweendeliriumandtheprimarycardiaccondition;theoccurrenceofdeliriumwasmorerelatedtothepresenceofhaemodynamicorelectricalinstability,infectiouscomplications,ordisordersoffluidsandelectrolytes.Elderlypatientsusuallypresentwithseveralpre-existingconditionsthatcanpredisposetodelirium(e.g.cognitiveimpairmentordementia,visualandhearingimpairment,depression),oractasprecipitatingfactors(useofpsychoactivedrugs,infections,electrolytedisturbances).Deliriumiscommoninthesepatients:themorecomplexandfrailthepatientis,thehighertherateofdelirium.Consequently,theoccurrenceofthissyndromeisstronglyrelatedtoworseoutcomes.Thepoorprognosisobservedamongdeliriouspatientscouldbeduetoseveralfactors,includingsevereeffectsonthecentralnervoussystem,acomplicationofprolongedhospitalizationandunderlyingcomorbidities.However,theavailableliteraturestilldoesnotclarifythenatureofthisassociationand,todate,itisunknownwhetherdeliriumrepresentsapotentiallymodifiableriskfactorforadverseoutcomesincriticallyillpatients,oramarkeroforgandysfunctionorsystemicdiseaseandanearlyindicatorforcomplicationsinthesettingofintensivecare.Deliriumiscommon,serious,costly,andunder-recognized.Increasedawarenessofclinicalstaffandearlyevaluationanddetectionofdeliriumfavouracloserfollow-upoffrailpatients,andmaypreventcomplications.Inarecentobservationalstudy,higherdeliriummonitoringadherencewasassociatedwithareductionofin-hospitalmortalityinmechanicallyventilatedpatients,andonecannotexcludethatsimilaroutcomescouldbefoundinanacutenon-intubatedpopulation.Therefore,itwouldbedesirablethataprotocolforidentificationandtreatmentofdeliriumisimplementedinhigh-risksettings,suchastheCICU.Conflictofinterest:nonedeclared. PublishedonbehalfoftheEuropeanSocietyofCardiology.Allrightsreserved.©TheAuthor2017.Forpermissions,pleaseemail:[email protected]. 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