Delirium: Take-Home Points For the Cardiovascular Clinician
Delirium is a severe neuropsychiatric syndrome with a high predilection for older adults with cardiovascular (CV) diseases and a condition that the CV team should become aware of and comfortable with diagnosis and management.1 The origin of delirium is from Latin – delirare – "to go out of the furrow", deviate from a straight line, to be deranged. With multiple triggers and variable duration (days to weeks and months [in approximately 20%]) there is substantial heterogeneity in its prevalence. Post-coronary artery bypass grafting prevalence is around 24%, while after a transfemoral access transcatheter aortic valve replacement it is 7.4% and up to 21% via other access sites.
Below are a few take-home points for the cardiovascular team:
- The hallmark of delirium is acute change in attention.
- Delirium is common, costly, and associated with significant morbidity and mortality.
- Understanding delirium is an opportunity to better understand brain pathophysiology and vulnerability.
- The incidence of delirium in cardiac surgery populations ranges from 11-46%, and there is an associated relative risk of 1.7 for cognitive dysfunction, 1.9 relative risk for functional decline afterwards.
- Elevated BUN/Creatinine, as is seen often in congestive heart failure patients, increases the relative risk for delirium by 2.0.
- Underlying vascular dementia and acute CV events can increase a patient's risk for delirium.
- Nonpharmacologic, multicomponent interventions are still the gold standard for preventing and treating delirium.
- No pharmacologic agent has been shown to prevent or treat delirium – and most antipsychotics have CV risks associated with their use (QTc prolongation).
- Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet 2014;383:911-22.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease, Sleep Apnea
Keywords: Aged, Incidence, Antipsychotic Agents, Prevalence, Creatinine, Risk, Blood Urea Nitrogen, Transcatheter Aortic Valve Replacement, Delirium, Dementia, Brain, Long QT Syndrome, Geriatrics
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