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Tan JF, Duan L, Han JC, Cui JJ. Clinical characteristics of delirium in older patients with first-ever acute myocardial infarction who underwent percutaneous coronary intervention : A retrospective study. Herz 2024:10.1007/s00059-024-05250-5. [PMID: 38829438 DOI: 10.1007/s00059-024-05250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/05/2024] [Accepted: 04/25/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Delirium is a serious complication of cardiac surgery and a common clinical problem. The study aimed to identify the incidence, risk factors, and outcomes of delirium in older patients (≥ 65 years) with first-ever acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). METHODS A retrospective cohort study was performed in a hospital in northern China. A total of 1033 older patients with first-ever AMI who underwent PCI between January 2018 and April 2021 were screened for delirium using the CAM-ICU method. Clinical and laboratory data were collected. RESULTS A total of 134 (12.97%) patients were diagnosed with delirium. Patients with delirium were older. The most common concomitant diseases were cardiac arrest, chronic renal failure, and a history of coronary artery bypass graft (CABG). Delirious patients experienced more times of mechanical ventilation, more intra-aortic balloon pump (IABP) support, high postoperative immediate pain score (VAS), more non-bedside cardiac rehabilitation, and longer total length of stay and cardiac care unit (CCU) time. Multivariable logistic regression showed that age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently associated with delirium. Delirium was an independent predictor of prolonged CCU stay, total length of stay, and 1‑year mortality. CONCLUSION Age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently closely related to delirium in older patients with first-ever AMI who underwent PCI. Delirium was associated with a higher 1‑year all-cause mortality.
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Affiliation(s)
- Jin-Feng Tan
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Road, Harbin, Heilongjiang Province, China
| | - Le Duan
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jin-Cheng Han
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Road, Harbin, Heilongjiang Province, China
| | - Jin-Jin Cui
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Road, Harbin, Heilongjiang Province, China.
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Noufi P, Anderson KM, Crowell N, White Y, Molina E, Rao SD, Groninger H. Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00048-X. [PMID: 38705515 DOI: 10.1016/j.jaclp.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND In critically ill patients, delirium is a prognostic indicator of morbidity and mortality. OBJECTIVE This study investigates the impact of a delirium diagnosis on outcomes after left ventricular assist device (LVAD) implantation. METHODS This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared preimplantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as reintubation rate, length of stay, discharge disposition, and readmission rates. RESULTS In total, 361 patients (26.7% women and 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Preimplantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P = 0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P = 0.007), 6-month (P = 0.004), and in-hospital mortality (P < 0.001), unplanned reintubations (P < 0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and intensive care unit length of stay were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to the hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant. CONCLUSIONS In this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse postsurgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.
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Affiliation(s)
- Paul Noufi
- Palliative Care, MedStar Harbor Hospital, Baltimore, MD; Georgetown University School of Medicine, Washington, DC.
| | | | - Nancy Crowell
- Georgetown University School of Nursing, Washington, DC
| | - Yasmine White
- Georgetown University School of Medicine, Washington, DC
| | - Ezequiel Molina
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC
| | - Sriram D Rao
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC
| | - Hunter Groninger
- Georgetown University School of Medicine, Washington, DC; Palliative Care, MedStar Washington Hospital Center, Washington, DC
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Isogai T, Michihata N, Okada A, Morita K, Matsui H, Miyawaki A, Jo T, Yasunaga H. Use of Japanese Herbal Kampo Medicine in Patients With Acute Cardiovascular Disease - A 12-Year Nationwide Cohort Analysis. Circ J 2024:CJ-23-0770. [PMID: 38583961 DOI: 10.1253/circj.cj-23-0770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Kampo, a Japanese herbal medicine, is approved for the treatment of various symptoms/conditions under national medical insurance coverage in Japan. However, the contemporary nationwide status of Kampo use among patients with acute cardiovascular diseases remains unknown.Methods and Results: Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified 2,547,559 patients hospitalized for acute cardiovascular disease (acute myocardial infarction, heart failure, pulmonary embolism, or aortic dissection) at 1,798 hospitals during the fiscal years 2010-2021. Kampo medicines were used in 227,008 (8.9%) patients, with a 3-fold increase from 2010 (4.3%) to 2021 (12.4%), regardless of age, sex, disease severity, and primary diagnosis. The top 5 medicines used were Daikenchuto (29.4%), Yokukansan (26.1%), Shakuyakukanzoto (15.8%), Rikkunshito (7.3%), and Goreisan (5.5%). From 2010 to 2021, Kampo medicines were initiated earlier during hospitalization (from a median of Day 7 to Day 3), and were used on a greater proportion of hospital days (median 16.7% vs. 21.4%). However, the percentage of patients continuing Kampo medicines after discharge declined from 57.9% in 2010 to 39.4% in 2021, indicating their temporary use. The frequency of Kampo use varied across hospitals, with the median percentage of patients prescribed Kampo medications increasing from 7.7% in 2010 to 11.5% in 2021. CONCLUSIONS This nationwide study demonstrates increasing Kampo use in the management of acute cardiovascular diseases, warranting further pharmacoepidemiological studies on its effectiveness.
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Affiliation(s)
- Toshiaki Isogai
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
- Cancer Prevention Center, Chiba Cancer Center Research Institute
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Atsushi Miyawaki
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Taisuke Jo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
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Aikawa Y, Ogata S, Honda S, Nagai T, Murata S, Morii I, Anzai T, Nishimura K, Noguchi T. Prolonged delirium during hospitalization is associated with worse long-term and short-term outcomes in patients with acute heart failure. Int J Cardiol 2024; 399:131776. [PMID: 38216062 DOI: 10.1016/j.ijcard.2024.131776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND The association between prolonged delirium during hospitalization and long-term prognosis in patients with acute heart failure (AHF) admitted to the cardiac intensive care unit (CICU) has not been fully elucidated. METHODS We conducted a prospective registry study of patients with AHF admitted to the CICU at 2 hospitals from 2013 to 2021. We divided study patients into 3 groups according to the presence or absence of delirium and prolonged delirium as follows: no delirium, resolved delirium, or prolonged delirium. Main outcomes were in-hospital mortality and 3-year mortality after discharge. RESULTS A total of 1555 patients with AHF (median age, 80 years) were included in the analysis. Of these, 406 patients (26.1%) developed delirium. We divided patients with delirium into 2 groups: the resolved delirium group (n = 201) or the prolonged delirium group (n = 205). Multivariate Cox proportional hazards models for long-term prognosis demonstrated that the prolonged delirium group had a higher incidence of all-cause death (hazard ratio [HR], 1.52; 95% CI, 1.08 to 2.14) and non-cardiovascular death (HR, 1.84; 95% CI, 1.21 to 2.78) than the resolved delirium group. Regarding in-hospital outcomes, multivariate logistic regression modeling showed that prolonged delirium is associated with all-cause death (odds ratio [OR], 9.55; 95% confidential interval [CI], 2.99 to 30.53) and cardiovascular death (OR, 13.02; 95% CI, 2.86 to 59.27) compared with resolved delirium. CONCLUSIONS Prolonged delirium is associated with worse long-term and short-term outcomes than resolved delirium in patients with AHF.
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Affiliation(s)
- Yukio Aikawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiology, Hokusetsu General Hospital, Takatsuki, Japan.
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shunsuke Murata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Isao Morii
- Department of Cardiology, Hokusetsu General Hospital, Takatsuki, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Nijskens CM, Thomas EG, Rhodius‐Meester HFM, Daemen MJAP, Biessels GJ, Handoko ML, Muller M. Is it time for Heart-Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure. Clin Cardiol 2024; 47:e24200. [PMID: 38183320 PMCID: PMC10785189 DOI: 10.1002/clc.24200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/20/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Cognitive impairment is highly prevalent among patients with heart failure (HF). International guidelines on the management of HF recommend screening for cognitive impairment and tailored care for patients with cognitive impairment. However, practical guidance is lacking. In this study, we explore cardiologists' perspective on screening and care for cognitive impairment in patients with HF. We give an example of a multidisciplinary Heart-Brain care pathway that facilitates screening for cognitive impairment in patients with HF. METHODS We distributed an online survey to cardiologists from the Dutch working groups on Geriatric Cardiology and Heart Failure. It covered questions about current clinical practice, impact of cognitive impairment on clinical decision-making, and their knowledge and skills to recognize cognitive impairment. RESULTS Thirty-six out of 55 invited cardiologists responded. Only 3% performed structured cognitive screening, while 83% stated that not enough attention is paid to cognitive impairment. More than half of the cardiologists desired more training in recognizing cognitive impairment and three-quarters indicated that knowing about cognitive impairment would change their treatment plan. Eighty percent agreed that systematic cognitive screening would benefit their patients and 74% wished to implement a Heart-Brain clinic. Time and expertise were addressed as the major barriers to screening for cognitive impairment. CONCLUSION Although cardiologists are aware of the clinical relevance of screening for cognitive impairment in cardiology patients, such clinical conduct is not yet commonly practiced due to lack of time and expertise. The Heart-Brain care pathway could facilitate this screening, thus improving personalized care in cardiology.
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Affiliation(s)
- Charlotte M. Nijskens
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
| | - Elias G. Thomas
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
| | - Hanneke F. M. Rhodius‐Meester
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Neurology, Alzheimer Center AmsterdamAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Geriatric MedicineOslo University HospitalOsloNorway
- Amsterdam NeuroscienceAmsterdam UMCAmsterdamThe Netherlands
| | - Mat J. A. P. Daemen
- Department of PathologyAmsterdam UMC Location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain CenterUniversity Medical CenterUtrechtThe Netherlands
| | - M. Louis Handoko
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
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Niu Z, Zhou J, Li Y. Prognostic significance of delirium in patients with heart failure: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1217965. [PMID: 37636295 PMCID: PMC10450942 DOI: 10.3389/fcvm.2023.1217965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] Open
Abstract
Background Delirium is a common symptom of heart failure (HF) and is associated with increased mortality, prolonged hospital stays, and heightened medical costs. The impact of delirium on the prognosis of HF patients is currently controversial. Therefore, we conducted a meta-analysis to evaluate the prognostic significance of delirium in HF. Methods Relevant articles were systematically searched in PubMed, Cochrane Library, Web of Science, and Embase based on the PRISMA guidelines. Studies that reported mortality and hospitalization-related outcomes in HF patients with or without delirium using raw or adjusted hazard ratio (HR) and odds ratio (OD) were included. Meta-analysis was then performed to evaluate the effect of delirium in HF patients. Outcomes of interest were all-cause mortality and events of the hospitalization. Results Of the 1,501 studies identified, 7 eligible studies involving 12,830,390 HF patients (6,322,846 males and 6,507,544 females) were included in the meta-analysis. There were 91,640 patients with delirium (0.71%) and 12,738,750 patients without delirium (99.28%). HF patients with delirium had higher OR for in-hospital mortality (1.95, 95% CI = 1.30-2.91, P = 0.135), higher pooled HR for 90-day mortality (2.64, 95% CI = 1.06-1.56, P = 0.215), higher pooled HR for 1-year mortality (2.08, 95% CI = 1.34-3.22, P = 0.004), and higher pooled HR for 30-day readmission rate (4.15, 95% CI = 2.85-6.04, P = 0.831) than those without delirium. Conclusion Current evidence suggests that combined delirium increases the risk of HF-related mortality and hospitalization-related outcomes in patients with HF. However, more research is needed to assess the impact of delirium on the prognosis of HF patients.
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Affiliation(s)
- Ziru Niu
- Department of Cardiovascular Medicine, The Second Hospital of HeBei Medical University, Shijiazhuang, China
| | - Jiamin Zhou
- Department of Hematology, The Second Hospital of HeBei Medical University, Shijiazhuang, China
| | - Yongjun Li
- Department of Cardiovascular Medicine, The Second Hospital of HeBei Medical University, Shijiazhuang, China
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Ang HP, Makpol S, Nasaruddin ML, Ahmad NS, Tan JK, Wan Zaidi WA, Embong H. Lipopolysaccharide-Induced Delirium-like Behaviour in a Rat Model of Chronic Cerebral Hypoperfusion Is Associated with Increased Indoleamine 2,3-Dioxygenase Expression and Endotoxin Tolerance. Int J Mol Sci 2023; 24:12248. [PMID: 37569622 PMCID: PMC10418785 DOI: 10.3390/ijms241512248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
Indoleamine 2,3-dioxygenase (IDO) and the tryptophan-kynurenine pathway (TRP-KP) are upregulated in ageing and could be implicated in the pathogenesis of delirium. This study evaluated the role of IDO/KP in lipopolysaccharide (LPS)-induced delirium in an animal model of chronic cerebral hypoperfusion (CCH), a proposed model for delirium. CCH was induced by a permanent bilateral common carotid artery ligation (BCCAL) in Sprague Dawley rats to trigger chronic neuroinflammation-induced neurodegeneration. Eight weeks after permanent BCCAL, the rats were treated with a single systemic LPS. The rats were divided into three groups: (1) post-BCCAL rats treated with intraperitoneal (i.p.) saline, (2) post-BCCAL rats treated with i.p. LPS 100 μg/kg, and (3) sham-operated rats treated with i.p. LPS 100 μg/kg. Each group consisted of 10 male rats. To elucidate the LPS-induced delirium-like behaviour, natural and learned behaviour changes were assessed by a buried food test (BFT), open field test (OFT), and Y-maze test at 0, 24-, 48-, and 72 h after LPS treatment. Serum was collected after each session of behavioural assessment. The rats were euthanised after the last serum collection, and the hippocampi and cerebral cortex were collected. The TRP-KP neuroactive metabolites were measured in both serum and brain tissues using ELISA. Our data show that LPS treatment in CCH rats was associated with acute, transient, and fluctuated deficits in natural and learned behaviour, consistent with features of delirium. These behaviour deficits were mild compared to the sham-operated rats, which exhibited robust behaviour impairments. Additionally, heightened hippocampal IDO expression in the LPS-treated CCH rats was associated with reduced serum KP activity together with a decrease in the hippocampal quinolinic acid (QA) expression compared to the sham-operated rats, suggested for the presence of endotoxin tolerance through the immunomodulatory activity of IDO in the brain. These data provide new insight into the underlying mechanisms of delirium, and future studies should further explore the role of IDO modulation and its therapeutic potential in delirium.
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Affiliation(s)
- Hui Phing Ang
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia (N.S.A.)
| | - Suzana Makpol
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (M.L.N.); (J.K.T.)
| | - Muhammad Luqman Nasaruddin
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (M.L.N.); (J.K.T.)
| | - Nurul Saadah Ahmad
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia (N.S.A.)
| | - Jen Kit Tan
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (M.L.N.); (J.K.T.)
| | - Wan Asyraf Wan Zaidi
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Hashim Embong
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia (N.S.A.)
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Shahu A, Banna S, Applefeld W, Rampersad P, Alviar CL, Ali T, Luk A, Fajardo E, van Diepen S, Miller PE. Liberation From Mechanical Ventilation in the Cardiac Intensive Care Unit. JACC. ADVANCES 2023; 2:100173. [PMID: 38939038 PMCID: PMC11198553 DOI: 10.1016/j.jacadv.2022.100173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/18/2022] [Accepted: 11/16/2022] [Indexed: 06/29/2024]
Abstract
The prevalence of respiratory failure is increasing in the contemporary cardiac intensive care unit (CICU) and is associated with a significant increase in morbidity and mortality. For patients that survive their initial respiratory decompensation, liberation from invasive mechanical ventilation (IMV) and the decision to extubate requires careful clinical assessment and planning. Therefore, it is essential for the CICU clinician to know how to assess and manage the various stages of IMV liberation, including ventilator weaning, evaluation of extubation readiness, and provide post-extubation care. In this review, we provide a comprehensive approach to liberation from IMV in the CICU, including cardiopulmonary interactions relative to withdrawal from positive pressure ventilation, evaluation of readiness for and assessment of spontaneous breathing trials, sedation management to optimize extubation, strategies for patients at a high risk for extubation failure, and tracheostomy in the cardiovascular patient.
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Affiliation(s)
- Andi Shahu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Soumya Banna
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Willard Applefeld
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Penelope Rampersad
- The Tomsich Family Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Connecticut, USA
| | - Carlos L. Alviar
- The Leon H. Charney Division of Cardiovascular Medicine, New York University Langone Medicine Center, New York, New York, USA
| | - Tariq Ali
- Division of Pulmonary and Critical Care, Mayo, Rochester, Minnesota, USA
| | - Adriana Luk
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Elaine Fajardo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sean van Diepen
- Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - P. Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Clinical phenotypes of delirium in patients admitted to the cardiac intensive care unit. PLoS One 2022; 17:e0273965. [PMID: 36054128 PMCID: PMC9439246 DOI: 10.1371/journal.pone.0273965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Limited data are available on clinical phenotype for delirium that occurs frequently among patients admitted to the cardiac intensive care unit (CICU). The objective of this study was to investigate the clinical pictures of delirium, and their association with clinical outcomes in CICU patients. Methods A total of 4,261 patients who were admitted to the CICU between September 1 2012 to December 31 2018 were retrospectively registered. Patients were excluded if they were admitted to the CICU for less than 24 hours or had missed data. Ultimately, 2,783 patients were included in the analysis. A day of delirium was defined as any day during which at least one CAM-ICU assessment was positive. The clinical risk factors of delirium were classified by the delirium phenotype, as follows; hypoxic, septic, sedative-associated, and metabolic delirium. Results The incidence of delirium was 24.4% at the index hospitalization in all CICU patients, and 22.6% within 7 days after CICU admission. The most common delirium phenotype was septic delirium (17.2%), followed by hypoxic delirium (16.8%). Multiple phenotypes were observed during most delirium days. Delirium most frequently occurred in patients with heart failure. Of all patients affected by delirium within 7 days, both ICU and hospital mortality significantly increased according to the combined number of delirium phenotypes. Conclusions Delirium occurred in a quarter of patients admitted to the modern CICU and was associated with increased in-hospital mortality. Therefore, more efforts are needed to reduce the clinical risk factors of delirium, and to prevent it in order to improve clinical outcomes in the CICU.
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Kim SE, Ko RE, Na SJ, Chung CR, Choi KH, Kim D, Park TK, Lee JM, Song YB, Choi JO, Hahn JY, Choi SH, Gwon HC, Yang JH. External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit. Front Cardiovasc Med 2022; 9:947149. [PMID: 35990989 PMCID: PMC9382019 DOI: 10.3389/fcvm.2022.947149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background No data is available on delirium prediction models in the cardiac intensive care unit (CICU), although preexisting delirium prediction models [PREdiction of DELIRium in ICu patients (PRE-DELIRIC) and Early PREdiction of DELIRium in ICu patients (E-PRE-DELIRIC)] were developed and validated based on a population admitted to the general intensive care unit (ICU). Therefore, we externally validated the usefulness of the PRE-DELIRIC and E-PRE-DELIRIC models and compared their predictive performance in patients admitted to the CICU. Methods A total of 2,724 patients admitted to the CICU were enrolled between September 2012 and December 2018. Delirium was defined as at least one positive Confusion Assessment Method for the ICU (CAM-ICU) which was screened at least once every 8 h. The PRE-DELIRIC value was calculated within 24 h of CICU admission, and the E-PRE-DELIRIC value was calculated at CICU admission. The predictive performance of the models was evaluated by using the area under the receiver operating characteristic (AUROC) curve, and the calibration slope was assessed graphically by plotting. Results Delirium occurred in 677 patients (24.8%) when the patients were assessed thrice daily until 7 days of the CICU stay. The AUROC curve for the prediction of delirium was significantly greater for PRE-DELIRIC values [0.84, 95% confidence interval (CI): 0.82–0.86] than for E-PRE-DELIRIC values (0.79, 95% CI: 0.77–0.80) [z score of −6.24 (p < 0.001)]. Net reclassification improvement for the prediction of delirium increased by 0.27 (95% CI: 0.21–0.32, p < 0.001). Calibration was acceptable in the PRE-DELIRIC model (Hosmer-Lemeshow p = 0.170) but not in the E-PRE-DELIRIC model (Hosmer-Lemeshow p < 0.001). Conclusion Although both models have good predictive performance for the development of delirium, even in critically ill cardiac patients, the performance of the PRE-DELIRIC model might be superior to that of the E-PRE-DELIRIC model. Further studies are required to confirm our results and design a specific delirium prediction model for CICU patients.
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Affiliation(s)
- Sung Eun Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Jeong Hoon Yang
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11
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Delirium and its association with short-term outcomes in younger and older patients with acute heart failure. PLoS One 2022; 17:e0270889. [PMID: 35881580 PMCID: PMC9321444 DOI: 10.1371/journal.pone.0270889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/18/2022] [Indexed: 11/19/2022] Open
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.
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12
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Uemura Y, Shibata R, Miyagaki Y, Takemoto K, Ishikawa S, Murohara T, Watarai M. A Comparative Study of Three Nutritional Risk/Screening Indices for Predicting Cardiac Events and Physical Functioning Among Patients with Acute Heart Failure. Int Heart J 2022; 63:541-549. [PMID: 35650154 DOI: 10.1536/ihj.21-809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Undernutrition is very common among patients with heart failure (HF). This study evaluated the prognostic values of three nutritional risk/screening indices among patients with acute HF. We retrospectively calculated scores for 465 patients with acute HF using the Controlling Nutritional Status (CONUT) tool, the Geriatric Nutritional Risk Index (GNRI), and the Mini-Nutritional Assessment Short Form (MNA-SF). The outcomes of interest were the 1-year rate of cardiac events (cardiac-related death or HF-related readmission) and the Barthel index as an index of physical function during hospitalization. The CONUT, GNRI, and MNA-SF scores were significantly correlated, although the proportions of a normal nutritional state varied (CONUT: 18.3%, GNRI: 32.9%, and MNA-SF: 43.9%). Kaplan-Meier estimates revealed that cardiac events were more common among patients with undernutrition based on the CONUT score, and multivariable regression analysis revealed that only the CONUT score independently predicted poor outcomes. Furthermore, changes in the Barthel index during hospitalization were significantly correlated with the CONUT score but not with the GNRI and MNA-SF scores. In receiver operating characteristic analyses, the CONUT score had the most powerful predictive values on both the postdischarge incidence of cardiac events and the decline of physical function during hospitalization compared with the GNRI and the MNA-SF. These results indicate that the CONUT score might provide useful information for predicting poor outcomes in patients with acute HF.
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Affiliation(s)
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine
| | | | | | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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13
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Ritchie C, Walters RW, Ramaswamy S, Alla VM. Impact of delirium on mortality in patients hospitalized for heart failure. Int J Psychiatry Med 2022; 57:212-225. [PMID: 34176306 DOI: 10.1177/00912174211028019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Heart Failure (HF) is one of the leading causes of hospitalization in the United States accounting for ≈800,000 hospital discharges and $11 billion in annual costs. Delirium occurs in approximately 30% of elderly hospitalized patients and its incidence is significantly higher among those admitted to the critical care units. Despite this, there has been limited exploration of the clinical and economic impact of delirium in patients hospitalized with acute HF. We hypothesized that delirium in HF is associated with excess mortality and hospital costs. METHODS We queried the 2001-2014 Nationwide Inpatient Sample to identify hospitalizations that included a primary discharge diagnosis of HF (ICD-9-CM: 428.xx) and stratified them by presence or absence of delirium (ICD-9-CM: 239.0, 290.41, 293.0, 293.1, 348.31). Differences in in-hospital mortality, length of stay (LOS), and hospital costs were assessed using propensity-score matched cohorts. RESULTS Major predictors of delirium included advanced age, Caucasian race, underlying dementia or psychiatric diagnoses, higher Elixhauser Comorbidity Index, renal failure, cardiogenic shock, and coronary artery bypass surgery. In the propensity-score matched analysis of 76,411 hospitalization with delirium compared to 76,612 without delirium, in-hospital mortality (odds ratio: 1.67, 95% CI: 1.51-1.77), LOS (rate ratio [RR]: 1.47, 95% CI: 1.45-1.51), and hospital costs (RR: 1.44, 95% CI: 1.41-1.48) were all statistically higher in the presence of delirium (all p < 0.001). CONCLUSION In patients hospitalized with HF, delirium is an independent predictor of increased in-hospital mortality, longer LOS, and excess hospital costs despite adjustment for baseline characteristics.
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Affiliation(s)
| | - Ryan W Walters
- Division of Clinical Research and Evaluative Sciences, 12282Creighton University School of Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Sriram Ramaswamy
- Department of Psychiatry, Creighton University School of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Venkata M Alla
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
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14
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Chu NM, Segev DL, McAdams-DeMarco MA. Delirium Among Adults Undergoing Solid Organ Transplantation. CURRENT TRANSPLANTATION REPORTS 2022; 8:118-126. [PMID: 35321347 DOI: 10.1007/s40472-021-00326-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose of Review To summarize the research on post-operative delirium among patients undergoing solid organ transplantation in efforts to improve recognition, evaluation, and management, as well as highlight areas for future research. Recent Findings Delirium is a common complication in patients with organ failure before and after undergoing solid organ transplant (range: 4.7-47%). However, it is frequently unrecognized and underdiagnosed-even among those closely monitored after major surgery-given that its manifestation is often variable and inconsistent. Delirium has multifactorial etiologies comprising of a complex mix of predisposing recipient, donor, and transplant factors, as well as intraoperative and perioperative factors. Evidence suggests that delirium risk increases with presence of a greater number of such risk factors, and can lead to adverse outcomes such as increased hospital length of stay, time in the ICU, time on mechanical ventilators, graft dysfunction, graft loss, and mortality. Though no trials have been conducted among transplant populations specifically, delirium has been shown to be preventable among hospitalized older adults generally. Multicomponent, primary prevention strategies designed to target multiple risk factors of delirium, such as cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration, have been identified as most effective. Whether these approaches translate to improvements in quality of life and long-term health outcomes among patients with organ failure before and after transplantation is yet to be determined. Summary Delirium is an important, common, yet potentially preventable complication among patients with organ failure. Future studies are needed to test the efficacy of multicomponent, primary prevention strategies on long-term health outcomes among these vulnerable populations.
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Affiliation(s)
- Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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15
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Lafo J, Singh M, Jiang L, Correia S, Madrigal C, Clements R, Wu WC, Erqou S, Rudolph JL. Outcomes in heart failure patients discharged to skilled nursing facilities with delirium. ESC Heart Fail 2022; 9:1891-1900. [PMID: 35293145 PMCID: PMC9065834 DOI: 10.1002/ehf2.13895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022] Open
Abstract
AIM Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and delirium with risk of hospital readmission and mortality in HF patients discharged to SNF. METHODS AND RESULTS The study population included Veterans hospitalized for a primary diagnosis of HF and discharged to SNFs between 2010 and 2015. Pre-existing dementia was identified based on International Classification of Diseases-9 codes. Delirium was determined using the Minimum Data Set 3.0 Confusion Assessment Method algorithm. Proportional hazard regression analyses were used to model outcomes and were adjusted for covariates of interest. Patients (n = 21 655) were older (77.0 ± 10.5 years) and predominantly male (96.9%). Four groups were created according to presence (+) or absence (-) of dementia and delirium. Relative to the dementia-/delirium- group, the dementia-/delirium+ group was associated with increased 30 day mortality [adjusted hazard ratio (HR) = 2.2, 95% confidence interval (CI) = 1.7, 3.0] and 365 day mortality (adjusted HR = 1.5, 95% CI = 1.3, 1.7). Readmission was highest in the dementia-/delirium+ group after 30 days (HR = 1.2, 95% CI = 1.0, 1.5). In the group with dementia (delirium-/dementia+), 30 day mortality (12.8%; HR = 0.7, 95% CI = 0.7, 0.8) and readmissions (5.3%; HR = 1.0, 95% CI = 0.8, 1.1) were not different relative to the reference group. CONCLUSIONS Delirium, independent of pre-existing dementia, confers increased risk of hospital readmission and mortality in HF patients discharged to SNFs. Managing HF after hospitalization is a complex cognitive task and an increased focus on mental status in the acute care setting prior to discharge is needed to improve HF management and transitional care, mitigate adverse outcomes, and reduce healthcare costs.
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Affiliation(s)
- Jacob Lafo
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Psychiatry & Human Behavior, Brown University, Providence, RI, USA
| | - Mriganka Singh
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Stephen Correia
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Psychiatry & Human Behavior, Brown University, Providence, RI, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Caroline Madrigal
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Rachel Clements
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Wen-Chih Wu
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sebhat Erqou
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James L Rudolph
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center for Gerontology, Brown University School of Public Health, Providence, RI, USA
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16
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Atypical Antipsychotic Safety in the CICU. Am J Cardiol 2022; 163:117-123. [PMID: 34794647 DOI: 10.1016/j.amjcard.2021.09.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022]
Abstract
Atypical antipsychotics are used in cardiac intensive care units (CICU) to treat delirium despite limited data on safety in patients with acute cardiovascular conditions. Patients treated with these agents may be at higher risk for adverse events such as QTc prolongation and arrhythmias. We performed a retrospective cohort study of 144 adult patients who were not receiving antipsychotics before admission and received olanzapine (n = 50) or quetiapine (n = 94) in the Michigan Medicine CICU. Data on baseline characteristics, antipsychotic dose and duration, length of stay, and adverse events were collected. Adverse events included ventricular tachycardia (sustained ventricular tachycardia attributed to the medication), hypotension (systolic blood pressure <90 mm Hg attributed to the medication), and QTc prolongation (QTc increase by ≥60 ms or to an interval ≥500 ms). Twenty-six patients (18%) experienced an adverse event. Of those adverse events, 20 patients (14%) experienced QTc prolongation, 3 patients (2%) had ventricular tachycardia, and 3 patients (2%) had hypotension. Patients who received quetiapine had a higher rate of adverse events (25% vs 6%, p = 0.01) including QTc prolongation (18% vs 6%, p = 0.046). Intensive care unit length of stay was shorter in patients who received olanzapine (6.5 vs 9.5 days, p = 0.047). Eighteen patients (13%) had their antipsychotic continued at discharge from the hospital. In conclusion, QTc prolongation was more common in patients treated with quetiapine versus olanzapine although the number of events was relatively low with both agents in a CICU cohort.
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17
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Kusunose K, Okushi Y, Okayama Y, Zheng R, Nakai M, Sumita Y, Ise T, Yamaguchi K, Yagi S, Fukuda D, Yamada H, Soeki T, Wakatsuki T, Sata M. Use of Echocardiography and Heart Failure In-Hospital Mortality from Registry Data in Japan. J Cardiovasc Dev Dis 2021; 8:jcdd8100124. [PMID: 34677193 PMCID: PMC8536984 DOI: 10.3390/jcdd8100124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Echocardiography requires a high degree of skill on the part of the examiner, and the skill may be more improved in larger volume centers. This study investigated trends and outcomes associated with the use and volume of echocardiographic exams from a real-world registry database of heart failure (HF) hospitalizations. Methods: This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). A first analysis was performed to assess the trend of echocardiographic examinations between 2012 and 2016. A secondary analysis was performed to assess whether echocardiographic use was associated with in-hospital mortality in 2015. Results: During this period, the use of echocardiography grew at an average annual rate of 6%. Patients with echocardiography had declining rates of hospital mortality, and these trends were associated with high hospitalization costs. In the 2015 sample, a total of 52,832 echocardiograms were examined, corresponding to 65.6% of all HF hospital admissions for that year. We found that the use and volume of echocardiography exams were associated with significantly lower odds of all-cause hospital mortality in heart failure (adjusted odds ratio (OR): 0.48 for use of echocardiography and 0.78 for the third tertile; both p < 0.001). Conclusions: The use of echocardiography was associated with decreased odds of hospital mortality in HF. The volumes of echocardiographic examinations were also associated with hospital mortality.
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Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
- Correspondence: ; Tel.: +81-88-633-7851; Fax: +81-88-633-7894
| | - Yuichiro Okushi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Yoshihiro Okayama
- Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima 770-8503, Japan;
| | - Robert Zheng
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.N.); (Y.S.)
| | - Yoko Sumita
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.N.); (Y.S.)
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8503, Japan;
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
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18
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Tersalvi G, Gasperetti A, Schiavone M, Dauw J, Gobbi C, Denora M, Krul JD, Cioffi GM, Mitacchione G, Forleo GB. Acute heart failure in elderly patients: a review of invasive and non-invasive management. J Geriatr Cardiol 2021; 18:560-576. [PMID: 34404992 PMCID: PMC8352772 DOI: 10.11909/j.issn.1671-5411.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute heart failure (AHF) is a major cause of unplanned hospitalisations in the elderly and is associated with high mortality. Its prevalence has grown in the last years due to population aging and longer life expectancy of chronic heart failure patients. Although international societies have provided guidelines for the management of AHF in the general population, scientific evidence for geriatric patients is often lacking, as these are underrepresented in clinical trials. Elderly have a different risk profile with more comorbidities, disability, and frailty, leading to increased morbidity, longer recovery time, higher readmission rates, and higher mortality. Furthermore, therapeutic options are often limited, due to unfeasibility of invasive strategies, mechanical circulatory support and cardiac transplantation. Thus, the in-hospital management of AHF should be tailored to each patient's clinical situation, cardiopulmonary condition and geriatric assessment. Palliative care should be considered in some cases, in order to avoid unnecessary diagnostics and/or treatments. After discharge, a strict follow-up through outpatient clinic or telemedicine is can improve quality of life and reduce rehospitalisation rates. The aim of this review is to offer an insight on current literature and provide a clinically oriented, patient-tailored approach regarding assessment, treatment and follow-up of elderly patients admitted for AHF.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Alessio Gasperetti
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Cecilia Gobbi
- Institut Cardiovasculaire de Caen, Hôpital Privé Saint Martin, Caen, France
| | - Marialessia Denora
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Joel Daniel Krul
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giacomo Maria Cioffi
- Division of Cardiology, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gianfranco Mitacchione
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Giovanni B. Forleo
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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Kawada K, Fukuda H, Kubo T, Ohta T, Ishida T, Morisawa S, Kawazoe T, Okamoto M, Fujita H, Jobu K, Morita Y, Ueba T, Kitaoka H, Miyamura M. Added value of anxiolytic benzodiazepines in predictive models on severe delirium in patients with acute decompensated heart failure: A retrospective analysis. PLoS One 2021; 16:e0250372. [PMID: 33886657 PMCID: PMC8062069 DOI: 10.1371/journal.pone.0250372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Delirium in patients with acute decompensated heart failure (ADHF) is associated with poor clinical outcomes. Although some medications have been reported as risk factors for delirium, their impact on patients with ADHF is still unclear. This study aimed to determine the association of specific medication use with delirium and their additive predictive value in models based on conventional risk factors. Methods and results In this single-center, retrospective study, 650 patients treated for ADHF were included. Fifty-nine patients (9.1%) had delirium. In multivariate analysis, anxiolytic benzodiazepines [odds ratio (OR): 6.4, 95% confidence interval (CI): 2.8–15], mechanical ventilation or noninvasive positive pressure ventilation (OR: 6.0, 95% CI: 2.9–12), depression (OR: 3.2, 95% CI: 1.5–6.5), intensive care or high care unit admission (OR: 2.9, 95% CI: 1.5–5.6), male sex (OR: 2.0, 95% CI: 1–3.7), and age (OR: 1.1, 95% CI: 1–1.1) were independently associated with severe delirium. The predictive model that included anxiolytic benzodiazepines had a significantly better discriminatory ability for the incidence of severe delirium than the conventional model. Conclusions The use of anxiolytic benzodiazepines was independently correlated with severe delirium, and their use in models based on conventional risk factors had an additive value for predicting delirium in patients with ADHF.
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Affiliation(s)
- Kei Kawada
- Graduate School of Integrated Arts and Sciences Kochi University, Oko town, Nankoku City, Kochi, Japan
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
- * E-mail:
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School Kochi University, Oko town, Nankoku City, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School Kochi University, Oko town, Nankoku City, Kochi, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, Suita City, Osaka, Japan
| | - Tomoaki Ishida
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Shumpei Morisawa
- Graduate School of Integrated Arts and Sciences Kochi University, Oko town, Nankoku City, Kochi, Japan
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Tetushi Kawazoe
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Manami Okamoto
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Hiroko Fujita
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Kohei Jobu
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Yasuyo Morita
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School Kochi University, Oko town, Nankoku City, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School Kochi University, Oko town, Nankoku City, Kochi, Japan
| | - Mitsuhiko Miyamura
- Graduate School of Integrated Arts and Sciences Kochi University, Oko town, Nankoku City, Kochi, Japan
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
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20
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Breit H, Bleck TP, Koffman L. Delirium in Cardiac and Cardiovascular Surgical Intensive Care Units. Semin Neurol 2021; 41:453-462. [PMID: 33851391 DOI: 10.1055/s-0041-1726283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Delirium is a common occurrence in cardiac and cardiovascular surgical intensive care units. Due to multiple confounding factors, this diagnosis remains challenging for medical professionals. Multiple theories exist regarding the pathophysiology of delirium, which include disruption of neurotransmitters as well as inflammation. Delirium has been associated with prolonged hospitalizations and an increase in mortality. Although there are widely used screening tools for delirium, none have been validated in this particular patient population. Limited treatments exist for delirium, so: both pharmacologic and nonpharmacologic preventative measures should be employed in this patient population.
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Affiliation(s)
- Hannah Breit
- Section of Neurocritical Care, Rush University Medical Center, Chicago, Illinois
| | - Thomas P Bleck
- Department of Neurology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Lauren Koffman
- Section of Neurocritical Care, Rush University Medical Center, Chicago, Illinois
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21
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Kwak MJ, Avritscher E, Holmes HM, Jantea R, Flores R, Rianon N, Chung TH, Balan P, Dhoble A. Delirium Among Hospitalized Older Adults With Acute Heart Failure Exacerbation. J Card Fail 2021; 27:453-459. [PMID: 33347994 DOI: 10.1016/j.cardfail.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Delirium among older adults hospitalized with acute heart failure is associated with increased mortality. However, studies concomitantly assessing the association of delirium with both clinical and economic outcomes in this population, such as mortality, hospital cost, or length of stay, are lacking. METHODS AND RESULTS We conducted a retrospective observational study using National Inpatient Sample data from 2011 to 2014. Using multivariable logistic regression, we assessed the association of delirium with in-hospital mortality, then estimated the incremental hospital cost and excessive length of stay adjusting for demographic and clinical factors using multivariable generalized linear regression. The association of other medical complications on clinical and economic outcomes was also assessed. A total of 568,565 (weighted N = 2,826,131) hospitalizations of patients 65 years or older with acute heart failure from 2011 to 2014 were included in the final analysis. The reported prevalence of delirium was 4.53%. After multivariable adjustment, delirium was associated with a 2.35-fold increase in the odds of in-hospital mortality (95% confidence interval [CI] 2.23-2.47), which was lower than the odds ratio for sepsis/septicemia (5.36; 95% CI, 5.02-5.72) or respiratory failure (4.53; 95% CI, 4.38-4.69), but similar to that for acute kidney injury (2.39; 95% CI, 2.31-2.48) and higher than for non-ST elevation myocardial infarct (1.57; 95% CI, 1.46-1.68). Delirium increased the total hospital cost by $4,262 (95% CI, $4,002-4,521) and the length of stay by 1.73 days (95% CI, 1.68-1.78), which was slightly lower than, but similar to, acute kidney injury ($4,771; 95% CI, $4,644-4,897) and 1.82 days (95% CI, 1.79-1.84), and higher than non-ST elevation myocardial infarct ($1,907; 95% CI, $1,629-2,185) and 0.31 days (95% CI, 0.25-0.37). CONCLUSIONS Delirium was associated with increased in-hospital mortality, total hospital cost, and length of stay, and the magnitude of the effect was similar to that for acute kidney injury. Enhanced efforts to prevent delirium are needed to decrease its adverse impact on clinical and economic outcomes for hospitalized older adults with acute heart failure.
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Affiliation(s)
- Min Ji Kwak
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Elenir Avritscher
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Holly M Holmes
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rachel Jantea
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Renee Flores
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nahid Rianon
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Tong Han Chung
- Healthcare Transformation Initiatives, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Prakash Balan
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Abhijeet Dhoble
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
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22
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Pak M, Hara M, Miura S, Furuya M, Tamaki M, Okada T, Watanabe N, Endo A, Tanabe K. Delirium is associated with high mortality in older adult patients with acute decompensated heart failure. BMC Geriatr 2020; 20:524. [PMID: 33272204 PMCID: PMC7713169 DOI: 10.1186/s12877-020-01928-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Delirium is associated with high mortality after cardiac surgery. However, evidence on the epidemiology of delirium in patients with acute decompensated heart failure (ADHF) is limited. This study aimed to assess the incidence and prognostic impact of delirium in patients with ADHF. METHODS This single-center prospective observational study enrolled 132 consecutive patients with ADHF. We utilized the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and classified the patients into two groups according to the presence or absence of delirium. The primary endpoint was 90-day all-cause mortality. The prognostic impact and risk factors of delirium were evaluated using multivariable Cox and logistic regression analyses, respectively. RESULTS The median patient age was 83 (interquartile range, 75-87) years. Approximately 51.5% were men. Delirium occurred in 36 (27.3%) patients, and hyperactive delirium was the most frequent type (86.1%). The 90-day all-cause mortality was higher in the patients with delirium than in those without (21.6% versus 3.9%, log-rank p = 0.002). Delirium was associated with higher mortality with an adjusted hazard ratio of 6.8 (95% confidence interval, 1.1-42.6, p = 0.042). The risk factors associated with delirium included advanced age, male sex, higher clinical frailty scale score, and dementia. CONCLUSIONS Delirium was associated with a higher 90-day all-cause mortality in the older adult patients with ADHF. Hyperactive delirium was the most common subtype.
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Affiliation(s)
- Misun Pak
- Department of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Masahiko Hara
- Center for Community-Based Healthcare Research and Education, Shimane University, Izumo, Japan.,Department of Clinical Investigation, Japan Society of Clinical Research, Osaka, Japan
| | - Shoko Miura
- Department of Psychiatry, Shimane University Faculty of Medicine, Izumo, Japan
| | - Motohide Furuya
- Department of Psychiatry, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masatake Tamaki
- Department of Clinical Investigation, Japan Society of Clinical Research, Osaka, Japan.,Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Taiji Okada
- Department of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Nobuhide Watanabe
- Department of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Akihiro Endo
- Department of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Kazuaki Tanabe
- Department of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
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Abstract
Purpose of Review Palliative care is increasingly acknowledged as beneficial in supporting patients and families affected by heart failure, but policy documents have generally focused on the chronic form of this disease. We examined palliative care provision for those with acute heart failure, based on the recently updated National Consensus Project Clinical Practice Guidelines for Quality Palliative Care. Recent Findings The commonest reason for hospitalization in those > 65 years, acute heart failure admissions delineate crisis points on the unpredictable disease trajectory. Palliative care is underutilized, often perceived as limited to end-of-life care rather than determined by regular systematic needs assessment. No dominant paradigm of palliative care provision has emerged from the nascent evidence base related to this clinical cohort, underscoring the need for further research. Summary Embedding palliative support as mainstream to heart failure care from the point of diagnosis may better ensure treatment strategies for those admitted with acute heart failure remain consistent with patients’ preferences and values.
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24
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Hayashi A, Kobayashi S, Matsui K, Akaho R, Nishimura K. The accuracy of delirium assessment by cardiologists treating heart failure inpatients: a single center retrospective survey. Biopsychosoc Med 2020; 14:15. [PMID: 32760437 PMCID: PMC7392711 DOI: 10.1186/s13030-020-00188-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background Patients with heart failure (HF) accompanied by delirium are at risk of rehospitalization and death, thus early detection and appropriate treatment is imperative. Palliative care for patients with HF is an important issue, particularly for patients who also have delirium. This retrospective study examined the accuracy of delirium assessment by cardiologists treating patients with HF, identified factors related to the detection of delirium, and recorded the initial treatment. Methods This was a retrospective chart survey of 165 patients with HF referred to a consultation liaison (C-L) service during treatment in the cardiology wards of a general hospital over a 6-year period. Diagnosis of delirium by the C-L psychiatrists was based on DSM-IV-TR. Cases in which cardiologists had stated “delirium” in the medical records were classified as an accurate assessment of delirium (Agreement group). Cases in which cardiologists did not state “delirium” were classified as Disagreement. Results Among 81 patients with delirium (51 [62.9%] male; 74.7 ± 13.3 years old), the ratio of accurate assessment of delirium by cardiologists was 50.6% (n = 41; Agreement group). Age, sex, and HF severity did not differ significantly between the two groups. Although disquietedness was identified most frequently (n = 59, 73%), only 33 of these 59 patients (55.9%) were recognized as having delirium by cardiologists. Inappropriate initial treatments were only noted in the Disagreement group. In both groups, most cases were referred to a C-L service without new medication for psychiatric symptoms. Conclusions An accurate assessment of the delirium of inpatients with HF by cardiologists was found in only around half of all cases. Accurate detection is important to avoid harmful drug administration and to provide appropriate palliative care.
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Affiliation(s)
- Anna Hayashi
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho 8-1, Shinjuku-ku, Tokyo, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho 8-1, Shinjuku-ku, Tokyo, Japan.,Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kentaro Matsui
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho 8-1, Shinjuku-ku, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.,Department of Clinical Laboratory, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho 8-1, Shinjuku-ku, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho 8-1, Shinjuku-ku, Tokyo, Japan
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25
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Gazda AJ, Kwak MJ, Akkanti B, Nathan S, Kumar S, de Armas IS, Baer P, Patel B, Kar B, Gregoric ID. Complications of LVAD utilization in older adults. Heart Lung 2020; 50:75-79. [PMID: 32709497 DOI: 10.1016/j.hrtlng.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Yearly rate and mean patient age of left ventricular assist device (LVAD) implantation increased from 2009 to 2014. Data are lacking regarding trends of LVAD implantation in older adults. OBJECTIVES To describe the trends of LVAD implantation in older adults and the clinical impact of associated procedural complications. METHODS We retrospectively analyzed the National Inpatient Sample from 2005 to 2014, calculated the percentage of older adults (>65 years of age) among those who underwent LVAD implantation, and compared their clinical characteristics. Primary outcomes were in-hospital mortality and discharge home. RESULTS In total, 4491 patients were included. The percentage of older adults among those receiving LVAD increased from 12.53% to 31.65% (p<0.01). Older adults were more likely to develop postoperative delirium (17.90% vs. 11.92% in younger patients; p<0.01), which portended lesser odds of discharge home. CONCLUSIONS Delirium develops with greater incidence in older adults undergoing LVAD implantation, which decreases odds of favorable discharge disposition.
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Affiliation(s)
- Alexander J Gazda
- Department of Internal Medicine, McGovern Medical School, Houston, TX
| | - Min Ji Kwak
- Department of Internal Medicine: Geriatric and Palliative Care Medicine, McGovern Medical School, 6431 Fannin St MSB 5.126 Houston, TX 77030, USA.
| | - Bindu Akkanti
- Department of Internal Medicine, McGovern Medical School, Houston, TX; Department of Internal Medicine: Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Sriram Nathan
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Ismael Salas de Armas
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Patrick Baer
- Memorial Hermann Hospital, Trauma Service Line, Houston, TX, USA
| | - Bela Patel
- Department of Internal Medicine, McGovern Medical School, Houston, TX; Department of Internal Medicine: Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
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26
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Affiliation(s)
- Christian S Guay
- From the Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
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27
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Semsar-Kazerooni K, Dima D, Valiquette J, Berube-Dufour J, Goldfarb M. Early Mobilization in People With Acute Cardiovascular Disease. Can J Cardiol 2020; 37:232-240. [PMID: 32739452 DOI: 10.1016/j.cjca.2020.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early mobilization (EM) is recommended in critical care units. However, there is little known about EM in people with acute cardiovascular disease. METHODS Consecutive admissions to a tertiary-care cardiovascular intensive care unit (CICU) before and after implementation of an EM program were reviewed. The Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk >20 m), was used to measure and guide mobility. The primary outcome was discharge home. RESULTS There were 1489 patients included in the analysis (preintervention, N = 637; intervention, N = 852). There were no differences in age, sex, or admission for ischemic heart disease (age 68.1 ± 16.1 years; 39.3% female). In the intervention cohort, one-quarter (N = 222; 26.1%) had at least mildly impaired prehospital functional status. The LOF was 4.6 ± 0.7 prehospital, 3.2 ± 1.4 on admission, and 4.2 ± 0.9 on CICU discharge. Half of patients (51.6%) increased their LOF by ≥1 during CICU admission. Nearly all mobility opportunities had a mobility activity (97.0%). The adverse event rate was 0.3% with no life-threatening events, falls, line dislodgements, or health care personnel injuries. The intervention group, compared with the preintervention group, was more likely to be discharged home (83.9% vs 78.3%, P < 0.007) and had a lower rate of in-hospital death (4.2% vs 6.8%; P = 0.04). When adjusted for age, sex, and comorbid illness, admission LOF was a predictor of discharge to health care facility (odds ratio = 0.72; P < 0.001). CONCLUSIONS EM is safe and feasible in the CICU and effective at increasing discharge home.
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Affiliation(s)
| | - Diana Dima
- Department of Nursing, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Julie Valiquette
- Division of Physiotherapy, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Joelle Berube-Dufour
- Department of Occupational Therapy, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Québec, Canada.
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Utility of the Nutritional Screening in Predicting Adverse Outcome of Patients With Overweight/Obesity and Acute Heart Failure. J Card Fail 2020; 26:566-573. [PMID: 32119916 DOI: 10.1016/j.cardfail.2020.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/15/2020] [Accepted: 02/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Undernutrition is a negative predictor of adverse outcomes in patients with heart failure (HF). Despite the survival advantage of elevated body mass index (BMI) in patients with HF, BMI does not necessarily reflect a favorable nutritional status. In the present study, we investigated the clinical impact of nutritional screening in patients with HF and overweight/obesity. METHODS We examined the data from 170 patients with overweight or obesity status (defined as BMI ≥ 25 kg/m2) who admitted for acute HF. Their controlling nutritional status (CONUT) score was calculated on admission. The CONUT score is regarded as an index of the nutritional status. RESULTS The median duration of follow-up was 1096 days (interquartile range, 805-1096 days). Undernutrition was identified in 66.5% of the patients. Kaplan-Meier survival analysis demonstrated that patients with undernutrition had a higher incidence of all-cause death and readmission due to HF than those without undernutrition. Multivariate Cox regression analysis revealed that the CONUT score, but not BMI and the geriatric nutritional risk index, was independently correlated with poor prognosis. CONCLUSIONS Undernutrition is highly prevalent and independently predicts poor outcomes in patients with overweight/obesity and acute HF.
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29
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Iwata E, Kondo T, Kato T, Okumura T, Nishiyama I, Kazama S, Ishihara T, Kondo S, Hiraiwa H, Tsuda T, Ito M, Aoyama M, Tanimura D, Awaji Y, Unno K, Murohara T. Prognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit. Can J Cardiol 2020; 36:1649-1657. [PMID: 32615071 DOI: 10.1016/j.cjca.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Delirium is a common adverse event observed in patients admitted to the intensive care unit (ICU). However, the prognostic value of delirium and its determinants have not been thoroughly investigated in patients with acute heart failure (AHF). METHODS We investigated 408 consecutive patients with AHF admitted to the ICU. Delirium was diagnosed by means of the Confusion Assessment Method for ICU tool and evaluated every 8 hours during the patients' ICU stays. RESULTS Delirium occurred in 109 patients (26.7%), and the in-hospital mortality rate was significantly higher in patients with delirium (13.8% vs 2.3%; P < 0.001). Multivariate logistic regression analysis showed that delirium independently predicted in-hospital mortality (odds ratio [OR] 4.33, confidence interval [CI] 1.62-11.52; P = 0.003). Kaplan-Meier analysis showed that the 12-month mortality rate was significantly higher in patients with delirium compared with those without (log-rank test: P < 0.001), and Cox proportional hazards analysis showed that delirium remained an independent predictor of 12-month mortality (hazard ratio 2.19, 95% CI 1.49-3.25; P < 0.001). The incidence of delirium correlated with severity of heart failure as assessed by means of the Get With The Guidelines-Heart Failure risk score (chi-square test: P = 0.003). Age (OR 1.05, 95% CI 1.02-1.09; P = 0.003), nursing home residential status (OR 3.32, 95% CI 1.59-6.94; P = 0.001), and dementia (OR 5.32, 95% CI 2.83-10.00; P < 0.001) were independently associated with the development of delirium. CONCLUSIONS Development of delirium during ICU stay is associated with short- and long-term mortality and is predicted by the severity of heart failure, nursing home residential, and dementia status.
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Affiliation(s)
- Etsuo Iwata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Toshiaki Kato
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Itsumure Nishiyama
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Shingo Kazama
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Toshikazu Ishihara
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Sayano Kondo
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takuma Tsuda
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Masanori Ito
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Morihiko Aoyama
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Daisuke Tanimura
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Yoshifumi Awaji
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan
| | - Kazumasa Unno
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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30
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Cai S, Latour JM, Lin Y, Pan W, Zheng J, Xue Y, Gao J, Lv M, Zhang X, Luo Z, Wang C, Zhang Y. Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study. Eur J Cardiovasc Nurs 2019; 19:310-319. [PMID: 31674797 DOI: 10.1177/1474515119886155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. AIMS The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. METHODS We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. RESULTS Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27-4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95-1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09-7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. CONCLUSION Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.
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Affiliation(s)
- Shining Cai
- Department of Nursing, Zhongshan Hospital, China
| | - Jos M Latour
- School of Nursing and Midwifery, University of Plymouth, UK
| | - Ying Lin
- Department of Nursing, Zhongshan Hospital, China
| | - Wenyan Pan
- Department of Nursing, Zhongshan Hospital, China
| | - Jili Zheng
- Department of Nursing, Zhongshan Hospital, China
| | - Yan Xue
- Department of Nursing, Zhongshan Hospital, China
| | - Jian Gao
- Department of Biostatistics, Zhongshan Hospital, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, China
| | | | - Zhe Luo
- Department of Cardiac Surgical Intensive Care Unit, Zhongshan Hospital, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital, China
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Mossello E, Baroncini C, Pecorella L, Giulietti C, Chiti M, Caldi F, Cavallini MC, Simoni D, Baldasseroni S, Fumagalli S, Valoti P, Stroppa S, Parenti K, Ungar A, Masotti G, Marchionni N, Bari MD. Predictors and prognosis of delirium among older subjects in cardiac intensive care unit: focus on potentially preventable forms. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2019; 9:771-778. [PMID: 31617374 DOI: 10.1177/2048872619882359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Delirium is a common and potentially preventable condition in older individuals admitted to acute and intensive care wards, associated with negative prognostic effects. Its clinical relevance is being increasingly recognised also in cardiology settings. The aim of the present study was to assess the prevalence, incidence, predictors and prognostic role of delirium in older individuals admitted to two cardiology intensive care units. METHODS All patients aged over 65 years consecutively admitted to the two participating cardiology intensive care units were enrolled. Assessment on admission included acute physiological derangement (modified rapid emergency medicine score, REMS), chronic comorbidity, premorbid disability and dementia. The Confusion Assessment Method-Intensive Care Unit was applied daily for delirium detection. RESULTS Of 497 patients (40% women, mean age 79 years), 18% had delirium over the entire cardiology intensive care unit course, half of whom more than 24 hours after admission (incident delirium). Advanced age, a main diagnosis of ST-segment elevation myocardial infarction or acute respiratory failure, modified REMS, comorbidity and dementia were independent predictors of delirium. Adjusting for patient's features on admission, incident delirium was predicted by invasive procedures (insertion of peripheral arterial catheter, urinary catheter, central venous catheter, naso-gastric tube and intra-aortic balloon pump). In a logistic regression model, delirium was an independent predictor of inhospital mortality (odds ratio 3.18, 95% confidence interval 1.02, 9.93). CONCLUSIONS Eighteen per cent of older cardiology intensive care unit patients had delirium, with half of the cases being incident, thus potentially preventable. Invasive procedures were independently associated with incident delirium. Delirium was an independent predictor of inhospital mortality. Awareness of delirium should be increased in the cardiology intensive care unit setting and prevention studies are warranted.
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Affiliation(s)
- Enrico Mossello
- Division of Geriatric Medicine and Cardiology, AOU Careggi, Firenze, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Caterina Baroncini
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Laura Pecorella
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Chiara Giulietti
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Maurizio Chiti
- Division of Cardiology, Pistoia, Azienda USL Toscana Centro, Italy
| | - Francesca Caldi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | - David Simoni
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | - Stefano Fumagalli
- Division of Geriatric Medicine and Cardiology, AOU Careggi, Firenze, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Paolo Valoti
- Division of Geriatric Medicine and Cardiology, AOU Careggi, Firenze, Italy
| | - Stefano Stroppa
- Division of Cardiology, Pistoia, Azienda USL Toscana Centro, Italy
| | - Katia Parenti
- Division of Cardiology, Pistoia, Azienda USL Toscana Centro, Italy
| | - Andrea Ungar
- Division of Geriatric Medicine and Cardiology, AOU Careggi, Firenze, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Giulio Masotti
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Niccolò Marchionni
- Division of Geriatric Medicine and Cardiology, AOU Careggi, Firenze, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Mauro Di Bari
- Division of Geriatric Medicine and Cardiology, AOU Careggi, Firenze, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Italy
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33
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Eljaiek R, Cavayas Y, Rodrigue E, Desjardins G, Lamarche Y, Toupin F, Denault A, Beaubien-Souligny W. High postoperative portal venous flow pulsatility indicates right ventricular dysfunction and predicts complications in cardiac surgery patients. Br J Anaesth 2019; 122:206-214. [DOI: 10.1016/j.bja.2018.09.028] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/29/2018] [Accepted: 09/23/2018] [Indexed: 12/20/2022] Open
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de Pablos L, Jorge-Brito RA, Amarnani V, Jiménez-Sosa A, González-Colaço Harmand M, Domínguez-Rodríguez A. Delirio en pacientes con insuficiencia cardiaca: influencia de los tiempos de asistencia en un servicio de urgencia hospitalario. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2017.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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35
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Correlation of Nutritional Indices on Admission to the Coronary Intensive Care Unit with the Development of Delirium. Nutrients 2018; 10:nu10111712. [PMID: 30413062 PMCID: PMC6267104 DOI: 10.3390/nu10111712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Delirium is a common occurrence in patients admitted to the intensive care unit and is related to mortality and morbidity. Malnutrition is a predisposing factor for the development of delirium. Nevertheless, whether the nutritional status on admission anticipates the development of delirium in patients with acute cardiovascular diseases remains unknown. OBJECTIVE This study aims to assess the correlation between the nutritional status on admission using the nutritional index and the development of delirium in the coronary intensive care unit. DESIGN We examined 653 consecutive patients (mean age: 70 ± 14 years) admitted to the coronary intensive care unit of Juntendo University Hospital between January 2015 and December 2016. We evaluated three nutritional indices frequently used to assess the nutritional status, i.e., Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT). We defined delirium as patients with a delirium score >4 using the Intensive Care Delirium Screening Checklist. RESULTS Delirium was present in 58 patients. All nutritional indices exhibited a tendency for malnutrition in the delirium group compared with the non-delirium group (GNRI, 86.5 ± 9.38 versus 91.6 ± 9.89; PNI, 36.4 ± 6.95 versus 41.6 ± 7.62; CONUT, 5.88 ± 3.00 versus 3.61 ± 2.56; for all, p < 0.001). Furthermore, the maximum delirium score increased progressively from the low- to the high-risk group, as evaluated by each nutritional index (GNRI, PNI, CONUT; for all, p < 0.001). A multivariate analysis revealed that the PNI and CONUT were independent risk factors for the occurrence of delirium. CONCLUSIONS A marked correlation exists between the nutritional index on admission, especially PNI and CONUT, and the development of delirium in patients with acute cardiovascular diseases, suggesting that malnutrition assessment upon admission could help identify patients at high risk of developing delirium.
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36
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Nagai T, Sundaram V, Rothnie K, Quint JK, Shoaib A, Shiraishi Y, Kohsaka S, Piper S, McDonagh TA, Hardman SMC, Goda A, Mizuno A, Kohno T, Rigby AS, Yoshikawa T, Clark AL, Anzai T, Cleland JGF. Mortality after admission for heart failure in the UK compared with Japan. Open Heart 2018; 5:e000811. [PMID: 30228905 PMCID: PMC6135420 DOI: 10.1136/openhrt-2018-000811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022] Open
Abstract
Objective Mortality amongst patients hospitalised for heart failure (HHF) in Western and Asian countries may differ, but this has not been investigated using individual patient-level data (IPLD). We sought to remedy this through rigorous statistical analysis of HHF registries and variable selection from a systematic literature review. Methods and results IPLD from registries of HHF in Japan (n=3781) and the UK (n=894) were obtained. A systematic literature review identified 23 models for predicting outcome of HHF. Five variables appearing in 10 or more reports were strongly related to prognosis (systolic blood pressure, serum sodium concentration, age, blood urea nitrogen and creatinine). To compare mortality in the UK and Japan, variables were imputed in a propensity model using inverse probability of treatment weighting (IPTW) and IPTW with logistic regression (doubly robust IPTW). Overall, patients in the UK were sicker and in-patient and post-discharge mortalities were greater, suggesting that the threshold for hospital admission was higher. Covariate-adjusted in-hospital mortality was similar in the UK and Japan (IPTW OR: 1.14, 95% CI 0.70 to 1.86), but 180-day postdischarge mortality was substantially higher in the UK (doubly robust IPTW OR: 2.33, 95% CI 1.58 to 3.43). Conclusions Despite robust methods to adjust for differences in patient characteristics and disease severity, HHF patients in the UK have roughly twice the mortality at 180 days compared with those in Japan. Similar analyses should be done using other data sets and in other countries to determine the consistency of these findings and identify factors that might inform healthcare policy and improve outcomes.
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Affiliation(s)
- Toshiyuki Nagai
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Varun Sundaram
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Royal Brompton and Harefield Hospitals, London, UK
| | - Kieran Rothnie
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, University of Keele and Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Susan Piper
- Cardiology Department, King's College Hospital, London, UK
| | | | - Suzanna Marie C Hardman
- Clinical and Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK
| | - Ayumi Goda
- Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St Luke's International Hospital, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Alan S Rigby
- Department of Statistics, Hull York Medical School, University of Hull, Kingston-upon-Hull, UK
| | | | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - John G F Cleland
- Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK.,Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College London, London, UK
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Mailhot T, Cossette S, Lambert J, Beaubien-Souligny W, Cournoyer A, O'Meara E, Maheu-Cadotte MA, Fontaine G, Bouchard J, Lamarche Y, Benkreira A, Rochon A, Denault A. Delirium After Cardiac Surgery and Cumulative Fluid Balance: A Case-Control Cohort Study. J Cardiothorac Vasc Anesth 2018; 33:93-101. [PMID: 30122614 DOI: 10.1053/j.jvca.2018.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess a novel hypothesis to explain delirium after cardiac surgery through the relationship between cumulative fluid balance and delirium. This hypothesis involved an inflammatory process combined with a hypervolemic state, which could lead to venous congestion reaching the brain. DESIGN Retrospective case-control (1:1) cohort study. SETTING University-affiliated tertiary cardiology center. PARTICIPANTS Cardiac surgery intensive care unit (ICU) patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Cumulative fluid balance was evaluated at 3 times: (1) upon arrival at the ICU after surgery, (2) 24 hours post-ICU arrival, and (3) 48 hours post-ICU arrival. A generalized estimated equation was used to model the association between cumulative fluid balance and delirium occurrence 24 hours later. Covariates were selected based on the statistical differences between cases and controls on delirium risk factors and clinical characteristics. The cohort included 346 patients, of which 39 (11%), 104 (30%), and 142 patients (41%) presented delirium at 24, 48, and 72 hours post-ICU arrival, respectively. The effect of time had an odds ratio (OR) of 2.14, 95% confidence interval (CI) 1.603 to 2.851, and a p value < 0.001. The cumulative fluid balance was associated with delirium occurrence (OR 1.20, 95% CI: 1.066-1.355, p = .003). History of neurological disorder, having both hearing and visual impairment, type of procedure, perioperative cerebral oximetry, mean pulmonary artery pressure pre-cardiopulmonary bypass (CPB), and mean arterial pressure post-CPB also contributed to delirium in the model. CONCLUSION Delirium is associated with a cumulative fluid balance, but the extent through which this plays an etiologic role remains to be determined.
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Affiliation(s)
- Tanya Mailhot
- Faculty of Nursing, Faculty of Medicine, Université de Montréal, Montreal Heart Institute Research Center, 5000 Bélanger St, S-2490, Montreal, Quebec, H1T 1C8, Canada.
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Canada
| | - Jean Lambert
- School of Public Health, Department of Preventive Medicine, Montreal Heart Institute Research Center, Montreal, Canada
| | | | - Alexis Cournoyer
- Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | - Eileen O'Meara
- Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | | | - Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Canada
| | - Josée Bouchard
- Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | - Yoan Lamarche
- Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | - Aymen Benkreira
- Faculty of Medicine, Université de Sherbrooke, Montreal Heart Institute Research Center, Montreal, Canada
| | - Antoine Rochon
- Faculty of Medicine, Department of Anesthesiology, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | - André Denault
- Faculty of Medicine, Department of Anesthesiology, Université de Montréal, Montreal Heart Institute, Montreal, Canada
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Kalantar K, LaHue SC, DeRisi JL, Sample HA, Contag CA, Josephson SA, Wilson MR, Douglas VC. Whole-Genome mRNA Gene Expression Differs Between Patients With and Without Delirium. J Geriatr Psychiatry Neurol 2018; 31:203-210. [PMID: 29991314 PMCID: PMC6817976 DOI: 10.1177/0891988718785774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify differences in gene expression between patients with in-hospital delirium from a known etiology (urinary tract infection [UTI]) and patients with delirium from an unknown etiology, as well as from nondelirious patients. METHODS Thirty patients with delirium (8 with UTI) and 21 nondelirious patients (11 with UTI) were included in this prospective case-control study. Transcriptomic profiles from messenger RNA sequencing of peripheral blood were analyzed for gene expression and disease-specific pathway enrichment patterns, correcting for systemic inflammatory response syndrome. Genes and pathways with significant differential activity based on Fisher exact test ( P < .05, |Z score| >2) are reported. RESULTS Patients with delirium with UTI, compared to patients with delirium without UTI, exhibited significant activation of interferon signaling, upstream cytokines, and transcription regulators, as well as significant inhibition of actin cytoskeleton, integrin, paxillin, glioma invasiveness signaling, and upstream growth factors. All patients with delirium, compared to nondelirious patients, had significant complement system activation. Among patients with delirium without UTI, compared to nondelirious patients without UTI, there was significant activation of elF4 and p7056 K signaling. CONCLUSIONS Differences exist in gene expression between delirious patients due to UTI presence, as well as due to the presence of delirium alone. Transcriptional profiling may help develop etiology-specific biomarkers for patients with delirium.
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Affiliation(s)
- Katrina Kalantar
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Sara C. LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA,Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Hannah A. Sample
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Caitlin A. Contag
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Scott A. Josephson
- Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA,Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Michael R. Wilson
- Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA,Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Vanja C. Douglas
- Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA,Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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Nagai T, Sundaram V, Shoaib A, Shiraishi Y, Kohsaka S, Rothnie KJ, Piper S, McDonagh TA, Hardman SMC, Goda A, Mizuno A, Sawano M, Rigby AS, Quint JK, Yoshikawa T, Clark AL, Anzai T, Cleland JGF. Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan. Eur J Heart Fail 2018; 20:1179-1190. [PMID: 29846026 DOI: 10.1002/ejhf.1210] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/15/2018] [Accepted: 04/09/2018] [Indexed: 12/13/2022] Open
Abstract
AIMS Prognostic models for hospitalized heart failure (HHF) were developed predominantly for patients of European origin in the United States of America; it is unclear whether they perform similarly in other health care systems or for different ethnicities. We sought to validate published prediction models for HHF in the United Kingdom (UK) and Japan. METHODS AND RESULTS Patients in the UK (n =894) and Japan (n =3158) were prospectively enrolled and were similar in terms of sex (∼60% men) and median age (∼77 years). Models predicted that British patients would have a higher mortality than Japanese, which was indeed true both for in-hospital (4.8% vs. 2.5%) and 180-day (20.7% vs. 9.5%) mortality. The model c-statistics for the published/derivation (range 0.70-0.76) and Japanese (range 0.75-0.77) cohorts were similar and higher than for the UK (0.62-0.75) but models consistently overestimated mortality in Japan. For in-hospital mortality, the OPTIMIZE-HF model performed best, providing similar discrimination in published/derivation, UK and Japanese cohorts [c-indices: 0.75 (0.74-0.77); 0.75 (0.68-0.81); and 0.77 (0.70-0.83), respectively], and least overestimated mortality in Japan. For 180-day mortality, the c-statistics for the ASCEND-HF model were similar in published/derivation (0.70) and UK [0.69 (0.64-0.74)] cohorts but higher in Japan [0.75 (0.71-0.79)]; calibration was good in the UK but again overestimated mortality in Japan. CONCLUSION Calibration of published prediction models appears moderately accurate and unbiased when applied to British patients but consistently overestimates mortality in Japan. Identifying the reason why patients in Japan have a better than predicted prognosis is of great interest.
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Affiliation(s)
- Toshiyuki Nagai
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Varun Sundaram
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Harington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA, and Royal Brompton and Harefield Hospitals, London, UK
| | - Ahmad Shoaib
- Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kieran J Rothnie
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Susan Piper
- Cardiology Department, King's College Hospital, London, UK
| | | | - Suzanna M C Hardman
- Clinical & Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK
| | - Ayumi Goda
- Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Alan S Rigby
- Department of Statistics, Hull York Medical School, University of Hull, Kingston-upon-Hull, UK
| | - Jennifer K Quint
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - John G F Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow and National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College London, London, UK
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40
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Gorodeski EZ, Goyal P, Hummel SL, Krishnaswami A, Goodlin SJ, Hart LL, Forman DE, Wenger NK, Kirkpatrick JN, Alexander KP. Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future. J Am Coll Cardiol 2018; 71:1921-1936. [PMID: 29699619 PMCID: PMC7304050 DOI: 10.1016/j.jacc.2018.02.059] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/22/2018] [Accepted: 02/25/2018] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a quintessential geriatric cardiovascular condition, with more than 50% of hospitalizations occurring in adults age 75 years or older. In older patients, HF is closely linked to processes inherent to aging, which include cellular and structural changes to the myocardium, vasculature, and skeletal muscle. In addition, HF cannot be considered in isolation of physical functioning, or without the social, psychological, and behavioral dimensions of illness. The role of frailty, depression, cognitive impairment, nutrition, and goals of care are each uniquely relevant to the implementation and success of medical therapy. In this paper, we discuss a model of caring for older adults with HF through a 4-domain framework that can address the unique multidimensional needs and vulnerabilities of this population. We believe that clinicians who embrace this approach can improve health outcomes for older adults with HF.
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Affiliation(s)
- Eiran Z Gorodeski
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Parag Goyal
- Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California
| | - Sarah J Goodlin
- Geriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Medicine, Oregon Health & Sciences University, Portland, Oregon
| | - Linda L Hart
- Bon Secours Heart and Vascular Institute, Richmond, Virginia
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - James N Kirkpatrick
- Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington Medical Center, Seattle, Washington
| | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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Ibrahim K, McCarthy CP, McCarthy KJ, Brown CH, Needham DM, Januzzi JL, McEvoy JW. Delirium in the Cardiac Intensive Care Unit. J Am Heart Assoc 2018; 7:JAHA.118.008568. [PMID: 29453307 PMCID: PMC5850211 DOI: 10.1161/jaha.118.008568] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Khalil Ibrahim
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | | | | | - Charles H. Brown
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Dale M. Needham
- Department of Physical Medicine and RehabilitationJohns Hopkins University School of MedicineBaltimoreMD,Outcomes After Critical Illness and Surgery (OACIS) GroupDivision of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - James L. Januzzi
- Division of CardiologyDepartment of MedicineMassachusetts General HospitalBaim Institute for Clinical ResearchBostonMA,Cardiometabolic TrialsBaim Institute for Clinical ResearchBostonMA
| | - John W. McEvoy
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
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42
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de Pablos L, Jorge-Brito RA, Amarnani V, Jiménez-Sosa A, Harmand MGC, Domínguez-Rodríguez A. Delirium in Patients With Heart Failure: Influence of Attendance Times in an Emergency Department. ACTA ACUST UNITED AC 2018; 72:82-84. [PMID: 29373255 DOI: 10.1016/j.rec.2017.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/13/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Laura de Pablos
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain
| | - Rita Ainhoa Jorge-Brito
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain
| | - Veena Amarnani
- Servicio de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Alejandro Jiménez-Sosa
- Unidad de Investigación, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Magali González-Colaço Harmand
- Servicio de Farmacología Clínica, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Alberto Domínguez-Rodríguez
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain; Servicio de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
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Abstract
PURPOSE OF THE REVIEW The purpose of this review was to examine the recent literature on detecting cognitive impairment in patients with heart failure (HF) and the evidence indicating any ramifications of cognitive impairment on patient engagement in HF self-care. RECENT FINDINGS Mild cognitive impairment (MCI) is common in HF and impacts on patients' engagement in self-care, yet it is frequently not detected. The use of screening tools, even when brief, improves detection of MCI. However, the most sensitive, specific and feasible screening measure to use in practice is yet to be identified. A full neuropsychological assessment is required to determine a diagnosis of cognitive impairment and to identify the specific areas of cognitive deficit. In patients with HF, there appears to be differing clusters of cognitive deficits. Identification of these deficits may help inform the application of specific cognitive training strategies to ameliorating cognitive changes in HF patients and potentially enhance engagement in self-care. Screening for cognitive impairment is crucial in the management of HF patients to ensure that potential self-care deficits are prevented. The optimal screening tool is yet to be identified.
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van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 933] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
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45
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Reply to “delirium in heart failure”. Int J Cardiol 2017; 229:133. [DOI: 10.1016/j.ijcard.2016.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Delirium in heart failure. Int J Cardiol 2017; 229:132. [DOI: 10.1016/j.ijcard.2016.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 11/18/2022]
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