Delirium and its association with short-term outcomes in younger and older patients with acute heart failure

Abstract

Younger patients (18 to 65 years old) are often excluded from delirium outcome studies. We sought to determine if delirium was associated with short-term adverse outcomes in a diverse cohort of younger and older patients with acute heart failure (AHF). We conducted a multi-center prospective cohort study that included adult emergency department patients with confirmed AHF. Delirium was ascertained using the Brief Confusion Assessment Method (bCAM). The primary outcome was a composite outcome of 30-day all-cause death, 30-day all-cause rehospitalization, and prolonged index hospital length of stay. Multivariable logistic regression was performed, adjusting for demographics, cognitive impairment without delirium, and HF risk factors. Older age (≥ 65 years old)*delirium interaction was also incorporated into the model. Odds ratios (OR) with their 95% confidence intervals (95%CI) were reported. A total of 1044 patients with AHF were enrolled; 617 AHF patients were < 65 years old and 427 AHF patients were ≥ 65 years old, and 47 (7.6%) and 40 (9.4%) patients were delirious at enrollment, respectively. Delirium was significantly associated with the composite outcome (adjusted OR = 1.64, 95%CI: 1.02 to 2.64). The older age*delirium interaction p-value was 0.47. In conclusion, delirium was common in both younger and older patients with AHF and was associated with poorer short-term outcomes in both cohorts. Younger patients with acute heart failure should be included in future delirium outcome studies.

Characteristics of Delirium and Its Association with Sedation and In-Hospital Mortality in COVID-19 Patients on Veno-venous Extracorporeal Membrane Oxygenation

“…Our critically ill patients expectedly had a common occurrence of delirium, a well-known predictor of poor outcomes in the ICU 2,4,8,10 . Our nding in a relatively young cohort is consistent with a recent large-scale study on delirium in acute heart failure patients, in which delirium was similarly common in patients younger than 65 years old 10 . This highlights the importance of managing the underlying acute medical illness even in younger and healthier patients with a good cognitive reserve.…”

“…Delirium, characterized by acute and uctuating alterations in consciousness, often precipitated by underlying medical illness 1 , is the most common neurological complication observed in intensive care units (ICUs), with a reported prevalence of up to 82% in mechanically ventilated patients 2 . Delirium prevalence has been studied in critically ill patients, including those with post-operative complications 3 , general ICU needs 2,4,5 , acute respiratory distress syndrome 6 (ARDS), extracorporeal membrane oxygenation (ECMO) 7 support, intracerebral hemorrhage 8 , status epilepticus 9 , and acute heart failure 10 . In many of these studies 2,4,8,10 , delirium portended worsened patient survival.…”

“…Delirium prevalence has been studied in critically ill patients, including those with post-operative complications 3 , general ICU needs 2,4,5 , acute respiratory distress syndrome 6 (ARDS), extracorporeal membrane oxygenation (ECMO) 7 support, intracerebral hemorrhage 8 , status epilepticus 9 , and acute heart failure 10 . In many of these studies 2,4,8,10 , delirium portended worsened patient survival. While there is growing evidence purporting the association between heavy sedation and poor outcomes, ndings regarding delirium's role have been inconsistent, and it remains incompletely understood in patients on ECMO support [11][12][13] .…”

Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation

“…Delirium, which is characterized by acute and fluctuating alterations in consciousness, often precipitated by underlying medical illness ( 1 ), is the most common neurological complication observed in intensive care units (ICUs), with a reported prevalence of up to 82% in mechanically ventilated patients ( 2 ). Delirium prevalence has been studied in critically ill patients, including those with post-operative complications ( 3 ), general ICU needs ( 2 , 4 , 5 ), acute respiratory distress syndrome ( 6 ) (ARDS), extracorporeal membrane oxygenation (ECMO) ( 7 ) support, intracerebral hemorrhage ( 8 ), status epilepticus ( 9 ), and acute heart failure ( 10 ). In many of these studies ( 2 , 4 , 8 , 10 ), delirium portended worsened patient survival.…”

“…Delirium prevalence has been studied in critically ill patients, including those with post-operative complications ( 3 ), general ICU needs ( 2 , 4 , 5 ), acute respiratory distress syndrome ( 6 ) (ARDS), extracorporeal membrane oxygenation (ECMO) ( 7 ) support, intracerebral hemorrhage ( 8 ), status epilepticus ( 9 ), and acute heart failure ( 10 ). In many of these studies ( 2 , 4 , 8 , 10 ), delirium portended worsened patient survival. While there is growing evidence purporting the association between heavy sedation and poor outcomes, findings regarding delirium's role have been inconsistent, and it remains incompletely understood in patients on ECMO support ( 11 – 13 ).…”