Five-fold increase in mortality in acute cardiac patients with delirium

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A study published in European Heart Journal: Acute Cardiovascular Care indicates that delirium is associated with a five-fold increase in mortality in acute cardiac patients. Furthermore, it also shows that delirium was common and affected over half of acute cardiac patients aged 85 years and older.

The study included all patients aged 65 years and older admitted to two cardiac intensive care units during a period of 15 months. Only non-intubated patients were enrolled. Validated score systems and questionnaires were used to detect and diagnose the presence of delirium at admission or during the hospital stay. Delirious patients were closely followed by nursing and medical staff, who used a flowchart for delirium treatment. This included treating pain and anxiety, and discontinuing medications known to cause delirium. Patient survival at six months was determined by telephone call.

Investigators Giovanni Falsini (interventional cardiologist, San Donato Hospital, Arezzo, Italy) and others found that delirium was a frequent condition among elderly patients with acute cardiac diseases—the study population consisted of 726 patients with an average age of 79 years, of whom 15% had delirium (at admission or during the hospital stay). More than half (52%) of patients aged 85 years and older were delirious. Falsini et al also found that patients with delirium had a worse prognosis, with a five-fold increase in both in-hospital and 30-day mortality and a two-fold increase in six-month mortality. Delirium was not only a strong and independent factor in predicting mortality, but was also associated with longer hospital stay and more frequent rehospitalisations during follow-up.

Falsini comments: “Among hospitalised patients, those admitted to an intensive care unit are more likely to develop delirium and there are strategies to limit its consequences. Less is known about delirium and its significance in patients admitted to cardiac intensive care units. This study investigated the incidence and clinical impact of delirium in patients with acute cardiac diseases.”

He adds that delirium is a “common and serious condition in acute cardiac patients”, noting that such patients “stay in hospital longer, return to hospital more often, and are more likely to die in the short- and long-term.”

“Delirium is common, serious, costly and under-recognised. A protocol is needed to identify and treat delirium in high-risk settings, like cardiac intensive care units,” Falsini concludes.