Delirium in Patients With Heart Failure - Revista Española de ...

1 Acute heart failure (AHF) is a frequent diagnosis in emergency department (ED) patients,2 who often have predisposing factors for delirium, such as ... RevistaEspañoladeCardiología(EnglishEdition) ISSN:1885-5857 RevistaEspañoladeCardiologíaisaninternationalscientificjournaldevotedtothepublicationofresearcharticlesoncardiovascularmedicine.Thejournal,publishedsince1947,istheofficialpublicationoftheSpanishSocietyofCardiologyandfounderoftheRECPublicationsjournalfamily.ArticlesarepublishedinbothEnglishandSpanishinitselectronicedition. 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Seemore SNIP2020 0.703 Viewmoremetrics Hide JournalInformation Previousarticle | Nextarticle Vol.72.Issue1.Pages82-84(January2019) Léaloenespañol Share Share Print DownloadPDF Morearticleoptions ePub Statistics Vol.72.Issue1.Pages82-84(January2019) Scientificletter DOI:10.1016/j.rec.2017.10.045 Fulltextaccess DeliriuminPatientsWithHeartFailure:InfluenceofAttendanceTimesinanEmergencyDepartment Delirioenpacientesconinsuficienciacardiaca:influenciadelostiemposdeasistenciaenunserviciodeurgenciahospitalario Visits ... DownloadPDF LauradePablosa,RitaAinhoaJorge-Britoa,VeenaAmarnanib,AlejandroJiménez-Sosac,MagaliGonzález-ColaçoHarmandd,AlbertoDomínguez-Rodrígueza,b, Correspondingauthor [email protected]: aFacultaddeCienciasdelaSalud,UniversidadEuropeadeCanarias,LaOrotava,SantaCruzdeTenerife,SpainbServiciodeCardiología,HospitalUniversitariodeCanarias,SanCristóbaldeLaLaguna,SantaCruzdeTenerife,SpaincUnidaddeInvestigación,HospitalUniversitariodeCanarias,SanCristóbaldeLaLaguna,SantaCruzdeTenerife,SpaindServiciodeFarmacologíaClínica,HospitalUniversitariodeCanarias,SanCristóbaldeLaLaguna,SantaCruzdeTenerife,Spain Thisitemhasreceived ... Visits (Dailydataupdate) Articleinformation FullText Bibliography DownloadPDF Statistics Tables(2)Table1.ClassificationofPatientsHospitalizedWithHeartFailureasaFunctionoftheDevelopmentofDeliriumDuringHospitalAdmissionTable2.IndependentPredictorsofDeliriuminPatientsHospitalizedforHeartFailure.MultivariableAnalysisShowmoreShowless FullText TotheEditor, Deliriumisanacuteorganicbrainsyndromecharacterizedbyaglobaldeteriorationofcognitivefunctionsasaconsequenceofacutesomaticdisease.1Ithasbeenfoundthat10%to56%ofelderlypatientscanexperiencedeliriumduringhospitalization,andinSpainitsprevalenceinpatientsinnonsurgicalservicesis25%.1Acuteheartfailure(AHF)isafrequentdiagnosisinemergencydepartment(ED)patients,2whooftenhavepredisposingfactorsfordelirium,suchascomorbidityandbiochemicalparameters.3However,lessisknownabouttheparametersexternaltothepatientthatcouldleadtothedevelopmentofdelirium.Therefore,themainobjectiveofthisstudywastoanalyzetheimpactofattendancetimesintheEDonthedevelopmentofdeliriuminpatientswithAHFadmittedtoahospitalizationward.Weretrospectivelyanalyzed750patientswithAHFadmittedtothehospitalizationwardofatertiaryhospital.Weexcluded54patientswhodevelopeddeliriumintheED.Uponadmissiontothehospitalizationward,allpatientsunderwentaninitialinterviewtodetectdeliriumusingthereducedConfusionAssessmentMethod(CAM).4TheCAMinstrumentcomprises4items.Ithasbeenvalidatedforthediagnosisofdelirium,andhashighsensitivity(94%-100%)andspecificity(90%-95%).Deliriumisbasedon2primarymanifestations(acuteonsetandfluctuatingcourse,andinattention)and2secondarymanifestations(disorganizedthinkingandalteredlevelofconsciousness).Thediagnosisofdeliriumrequiresthepresenceofbothprimarymanifestationsandatleast1ofthesecondarymanifestations.4Demographic,clinical,blood,andtimedatawerecollected.Timedatawereanalyzedaccordingto3levels:a)admissiontimeintheEDuntilspecialistconsultationtore-evaluatehospitaladmission;b)timefromadmissionintheEDtoadmissiontoaninpatientfacility;andc)totalhospitalizationtime.Thisstudywasanobservationalstudy,andsowritteninformedconsentwasnotconsiderednecessary;nevertheless,atthestartoftheinterviewallpatientswereaskedfortheirverbalconsenttodatacollection.Demographicandotherbaselinedatawereanalyzedusingbasicdescriptivestatistics.Continuousvariablesareexpressedasmean±standarddeviationundertheassumptionofanormaldistributionandcategoricalvariablesareexpressedasnumbers(percentage).QuantitativevariableswerecomparedusingtheStudentttest,andassociationsbetweenqualitativevariablesweredeterminedusingthePearsonchi-squareorFisherexacttest.Multivariablelogisticregressionanalysiswasusedtoidentifythevariablesassociatedwiththedevelopmentofdeliriumduringhospitalization.StatisticalanalysiswasperformedusingtheSPSSsoftwarepackageversion20(SPSSInc.,Armonk,NewYork,UnitedStates).Table1showsthecharacteristicsofthestudypopulation.Ofthe696patientswithAHFadmittedtothehospitalizationward,148(21.2%)developedprimarymanifestationsat48hoursto72hoursofhospitalization.Groupcomparisonsshowedthatpatientswhodevelopeddeliriumweremorefrequentlymaleandhadalowerleftventricularejectionfraction.ThegroupwithdeliriumhadahigherprevalenceofapreviousmedicalhistoryofAHFanddiabetesmellitus.ThisgroupalsohadhigherconcentrationsofB-typenatriureticpeptideatthetimeofadmissiontotheED.Finally,thisgrouphadlongertimesfromadmissiontotheEDtoahospitalizationwardandlongerhospitalizationtimes.Afteradjustmentforothercovariates,themultivariableanalysisshowedthattimefromadmissiontotheEDtoadmissiontoahospitalizationwardwasanindependentpredictoroftheprimarymanifestations(Table2).Table1.ClassificationofPatientsHospitalizedWithHeartFailureasaFunctionoftheDevelopmentofDeliriumDuringHospitalAdmissionVariables  Withdelirium(n=148)  Withoutdelirium(n=548)  P  Age,y  67±10  68±11  .30  Femalesex  92(62.2)  404(73.7)  .006  LVEF,%  47.88±10.10  50.48±11.00  .008  TimefromadmissiontothehospitalEDtoadmissiontoaninpatientward,h  50.64±36.96  37.44±27.84  .01  AdmissiontimeinthehospitalEDuntilspecialistconsultationtore-evaluatehospitaladmission,h  10.80±23.76  6.96±14.88  .06  Totalhospitalizationtime,d  12.00±3.71  10.65±3.73  .001  Inhospitalmortality  10(6.8)  19(3.5)  .07  MedicalhistoryPreviousHFepisode  99(66.9)  304(55.5)  .01  Chronicischemicheartdisease  28(18.9)  83(15,1)  .26  Atrialfibrillation  27(18.2)  77(14,1)  .20  COPD  18(12.2)  54(9.9)  .41  CardiovascularriskfactorsHypertension  89(60.1)  347(63.3)  .47  Smoking  77(52.0)  268(48.9)  .50  Hypercholesterolemia  90(60.8)  302(56,1)  .21  Diabetesmellitus  71(48.0)  210(38.3)  .03  BloodanalysisHemoglobin,g/dL  14.10±1.51  14.20±1.58  .16  BNP,pg/mL  2572.64±1780.35  2046.45±1635.51  Sodium,mg/dL  138.18±3.31  138.36±3.14  .52  BNP,B-typenatriureticpeptide;COPD,chronicobstructivepulmonarydisease;ED,emergencydepartment;HF,heartfailure;LVEF,leftventricularejectionfraction.Unlessotherwiseindicated,dataareexpressedasNo.(%)ormean±standarddeviation.Table2.IndependentPredictorsofDeliriuminPatientsHospitalizedforHeartFailure.MultivariableAnalysis  OR(95%CI)  P  Leftventricularejectionfraction  0.97(0.95-0.98)  .001  TimefromadmissiontotheHEStoadmissiontoaninpatientward,h  1.14(1.03-1.26)  .01  Totalhospitalizationtime,d  1.08(1.03-1.13)  .002  Previousepisodeofheartfailure1.53(1.02-2.29)0.03  1.53(12.2)  .03  95%CI,95%confidenceinterval;ED,emergencydepartment;OR,oddsratio.Afteradjustmentforthefollowingvariables:age(P=0.55),sex(P=0.07),B-typenatriureticpeptide(P=0.058),andpresenceofdiabetesmellitus(P=0.26).ThedataobtainedweresimilartodataontheprevalenceofdeliriumduringhospitalizationinpatientswithAHF.5ThenoveltyofthisstudyisthatitisthefirsttoanalyzetheimpactoflengthofstayintheEDonthedevelopmentofdeliriuminpatientswithAHFadmittedtoahospitalizationward.InmanySpanishhospitals,theorganizationalstructureofEDs,particularlyduringmorningshifts,leadstotheprioritizationofcareofpatientsalreadyadmittedorexternalconsultations.Thissituationhinderstheoptimalmanagementofstablepatientswhoarecandidatesforhospitaladmission.1Themainlimitationofthepresentstudyisthatitisaretrospectiveobservationalstudyconductedinasinglehospital,anditthereforesuffersfromthebiasinherenttosuchstudies.However,theresultsshowtheneedtoreducethelengthoftimefromadmissiontotheEDtoadmissiontoahospitalizationwardinordertolowertheriskofpatientsdevelopingdelirium.Suchreductionswoulddecreasetotalhospitalizationtimesandthereforeleadtolowerhealthcosts. References[1]F.Formiga,A.SanJosé,A.López-Soto,D.Ruiz,A.Urrutia,E.Duaso.Prevalenceofdeliriuminpatientsadmittedbecauseofmedicalconditions.MedClin(Barc).,129(2007),pp.571-573Medline[2]E.Santas,E.Valero,A.Mollar,etal.BurdenofRecurrentHospitalizationsFollowinganAdmissionforAcuteHeartFailure:PreservedVersusReducedEjectionFraction.RevEspCardiol.,70(2017),pp.239-246http://dx.doi.org/10.1016/j.rec.2016.06.021|Medline[3]M.A.Rizzi,O.H.TorresBonafonte,A.Alquezar,etal.Prognosticvalueandriskfactorsofdeliriuminemergencypatientswithdecompensatedheartfailure.JAmMedDirAssoc.,16(2015),799.e1-e6[4]S.K.Inouye,C.H.VanDyck,C.A.Alessi,S.Balkin,A.P.Siegal,R.I.Horwitz.Clarifyingconfusion:theconfusionassessmentmethod.Anewmethodfordetectionofdelirium.AnnInternMed.,113(1990),pp.941-948Medline[5]S.Honda,T.Nagai,Y.Sugano,etal.Prevalence,determinants,andprognosticsignificanceofdeliriuminpatientswithacuteheartfailure.IntJCardiol.,222(2016),pp.521-527http://dx.doi.org/10.1016/j.ijcard.2016.07.236|Medline Copyright©2017.SociedadEspañoladeCardiología Congresses(OnlyavailableinSpanish) SEC2021-ElCongresodelaSaludCardiovascular Seemore Subscribetoournewsletter Tools Print Sendtoafriend Exportreference CrossMark Mendeley Statistics Recommendedarticles Thedangerof... 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