Delirium in the cardiac intensive care unit: Determinants and prognosis

Abdallah Fayssoil; Mickael Chen; Marie Hauguel-Moreau; Jessica Guillaume; Madalina Jacota; Olivier Dubourg; Tristan Cudennec; Nicolas Mansencal

doi:10.1016/j.acvd.2025.04.053

Delirium in the cardiac intensive care unit: Determinants and prognosis

Arch Cardiovasc Dis. 2025 May 23:S1875-2136(25)00312-2. doi: 10.1016/j.acvd.2025.04.053. Online ahead of print.

Authors

Abdallah Fayssoil¹, Mickael Chen², Marie Hauguel-Moreau², Jessica Guillaume³, Madalina Jacota³, Olivier Dubourg², Tristan Cudennec⁴, Nicolas Mansencal⁵

Affiliations

¹ Department of Cardiology, Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Hôpital Ambroise-Paré, AP-HP, Université de Versailles Saint-Quentin-en-Yvelines, 92100 Boulogne-Billancourt, France. Electronic address: abdallah.fayssoil@aphp.fr.
² Department of Cardiology, Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Hôpital Ambroise-Paré, AP-HP, Université de Versailles Saint-Quentin-en-Yvelines, 92100 Boulogne-Billancourt, France.
³ Clinical Research Unit, Hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France.
⁴ Department of Geriatrics, Hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France.
⁵ Department of Cardiology, Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Hôpital Ambroise-Paré, AP-HP, Université de Versailles Saint-Quentin-en-Yvelines, 92100 Boulogne-Billancourt, France; INSERM U1018, Centre for Research in Epidemiology and Population Health, Université de Versailles Saint-Quentin-en-Yvelines, 94800 Villejuif, France.

PMID: 40451692
DOI: 10.1016/j.acvd.2025.04.053

Abstract

Background: Older and critically ill patients are at risk of delirium in hospital.

Aim: To explore the factors associated with and the prognostic value of delirium in older patients in a cardiac intensive care unit (CICU).

Methods: All consecutive patients aged>75years admitted to a CICU from January 2018 to December 2018 were included.

Results: The study included 451 consecutive patients (47% male), with a median age of 83 (80-88)years and a median modified Charlson Comorbidity Index score of 1 (1-3). The median left ventricular ejection fraction was 55% (40-60%). The prevalence of delirium at admission was 6.8% (31 patients), and the frequency during the CICU stay was 11.9% (50 patients). Patients with delirium were older (P=0.044), with a history of cognitive disorders (P<0.001), stroke/transient ischaemic attack (P=0.046) and zopiclone use (P=0.001). Sepsis (odds ratio 22.8, 95% confidence interval [CI] 9-65; P<0.001) and cardiogenic shock (odds ratio 3.9, 95% CI 1.29-11.48; P=0.007) were pathological conditions present in patients with delirium. Geriatric factors associated with delirium were faecaloma (P=0.008), acute urinary retention (P=0.010), urinary catheter instauration (P<0.001) and opioid use (P=0.002). Patients with delirium had a longer CICU length of stay (3 (2-5) versus 2 (1-3) days; P<0.001) and a longer in-hospital length of stay (11 (5-21) versus 7 (3-12) days; P<0.001). In the multivariable analysis, delirium was associated with a higher risk of in-hospital death (hazard ratio 3.79, 95% CI 1.55-9.31: P=0.005), adjusted for N-terminal prohormone of B-type natriuretic peptide concentration.

Conclusions: The onset of delirium in older patients affects prognosis in the CICU. Physicians must search for geriatric factors, sepsis and cardiogenic shock in the context of delirium.

Keywords: Cardiac intensive care unit; Delirium; Heart; Prognosis.