Point Prevalence of Delirium and Its Subtypes in the Patients Admitted with Acute Coronary Syndrome in Cardiac ICU and Its Impact on Mortality

Article Information

Title: Point Prevalence of Delirium and Its Subtypes in the Patients Admitted with Acute Coronary Syndrome in Cardiac ICU and Its Impact on Mortality

Authors: Lalarukh Taimoor, Komal Baloch, Urwah Ikhlaq, Jawed Abubaker, Imran Ansari, Nawal Salah Ud Din, Musa Khan

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2022

Volume: 72

Issue: 2

Language: English

DOI: 10.51253/pafmj.v72i2.7444

Keywords: DeliriumAcute coronary syndromesCAM-ICUMortality.

Abstract

Objective: To measure the point prevalence of delirium in the patients admitted to the cardiac ICU with acute coronary syndromes, with particular attention to the most commonly noted delirium and the impact on ICU mortality and length of ICU stay.
Study Design: Prospective cohort study.
Place and Study Duration: National Institute of Cardiovascular Diseases, Karachi Pakistan, from Mar and Jul 2021.
Methodology: Consecutive adult patients with age &gt;18 years admitted to the cardiac ICU after acute coronary syndromes were assessed for delirium using the confusion assessment method (CAM)-ICU tool and Richmond agitation sedation score (&gt;-3). The types of delirium were also assessed.
Results: 201 patients were enrolled, half of patients with ST-elevation MI (51.2%) and shock (45.8%). Delirium was identified in 71 (35.3%) patients, 30 (42.2%) had hypoactive delirium and 41 (57.7%) had hyperactive delirium. In multivariable regression, independent risk factors for delirium were: sepsis 3.19 (1.15-8.87), uremia 4.12 (1.18-14.46), mechanical ventilation 7.58 (1.2-47.99), and non-invasive ventilation 8.55 (2.9-25.2). Overall mortality was 35 (17.4%); 27/71 (38%) vs. 8/130 (6.2%); p 0.001 in patients with and without delirium, respectively. In multivariable regression, delirium was an independent risk factor for mortality at 7.12 (2.16-2.23). The mean ICU stay was 7.772.36 days vs. 3.91.44 days; p 0.001 for patients with and without delirium.
Conclusion: The deleterious effect of delirium in terms of higher morbidity and mortality cannot be overemphasised. Hypoactive delirium is as common as the hyperactive type, with the same mortality risk. Assessment for delirium is mandatory for all patients admitted..............

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Research Objective

To measure the point prevalence of delirium in patients admitted to the cardiac ICU with acute coronary syndromes, identify the most common delirium subtype, and assess its impact on ICU mortality and length of ICU stay.

Methodology

Prospective cohort study conducted at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, from March to July 2021. Consecutive adult patients (age >18 years) admitted to the cardiac ICU after acute coronary syndromes were assessed for delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Richmond Agitation Sedation Scale (RASS). Delirium subtypes (hypoactive and hyperactive) were also assessed.

Methodology Flowchart

                        graph TD
    A["Enroll Consecutive Adult Patients with ACS in Cardiac ICU"] --> B["Assess for Delirium using CAM-ICU and RASS"];
    B --> C["Identify Delirium Presence and Subtype"];
    C --> D["Record ICU Mortality and Length of ICU Stay"];
    D --> E["Analyze Data for Prevalence, Risk Factors, and Impact"];
    E --> F["Draw Conclusions and Implications"];

Discussion

The study highlights a significant point prevalence of delirium in patients with acute coronary syndromes admitted to the cardiac ICU, with a substantial impact on mortality and length of ICU stay. Both hypoactive and hyperactive delirium subtypes were found to be common and associated with similar mortality risks. The findings underscore the importance of routine delirium assessment in this patient population.

Key Findings

Delirium was identified in 71 out of 201 (35.3%) patients. Of those with delirium, 41 (57.7%) had hyperactive delirium and 30 (42.3%) had hypoactive delirium. Patients with delirium had significantly higher ICU mortality (38% vs. 6.2%) and longer ICU stays (7.77 ± 2.37 days vs. 3.9 ± 1.45 days) compared to those without delirium. Independent risk factors for delirium included sepsis, uremia, mechanical ventilation, and non-invasive ventilation. Delirium was an independent risk factor for mortality.

Conclusion

The deleterious effects of delirium on morbidity and mortality in cardiac ICU patients with acute coronary syndromes are significant. Hypoactive delirium is as prevalent as hyperactive delirium and carries the same mortality risk. Routine assessment for delirium is mandatory for all patients admitted to the cardiac ICU.

Fact Check

1. Delirium Prevalence: Delirium was identified in 35.3% of the enrolled patients (71 out of 201).
2. Mortality with Delirium: Mortality in patients with delirium was 38% (27/71), compared to 6.2% (8/130) in patients without delirium.
3. ICU Stay: The mean ICU stay for patients with delirium was 7.77 ± 2.37 days, while for those without delirium, it was 3.9 ± 1.45 days.

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