Study Links Delirium to Hospitalized Older Adults with Acute Heart Failure Mortality

A possible link between delirium and mortality in hospitalized older adults with acute heart failure exacerbation has been found by researchers at The University of Texas Health Science Center at Houston (UTHealth).

The retrospective study was published in the Journal of Cardiac Failure.

Delirium causes mental confusion and social unawareness, and makes it difficult to think, remember, or sleep. It can be caused by medical illness, discomfort from surgery, medications, pain, or infection.

“Delirium is common in older adults who are hospitalized for long periods of time,” said Min Ji Kwak, MD, assistant professor in the Joan and Stanford Alexander Division of Geriatric and Palliative Medicine at McGovern Medical School at UTHealth and corresponding author on the study. “Although it is common, the exact etiology and management of delirium is not yet clearly established. So, I wanted to have a better understanding and compare the mortality and economic impact of delirium in older adults.”

Using National Inpatient Sample data from 2011 to 2014, investigators compared the association of delirium with in-hospital mortality, and determined older adults hospitalized with acute heart failure exacerbation who developed delirium were 2.35 times more likely to die in the hospital, spent $4,262 more in hospital bills, and stayed 1.73 more days in the hospital than those hospitalized with regular acute heart failure but who did not experience delirium.

Kwak says these findings show a dire need for delirium prevention and appropriate management in older adults with acute heart failure to help decrease both clinical and economic burden.

“When a patient is admitted for acute heart failure, physicians may only focus on their heart failure management, but it is more than just the heart that needs to be addressed. I want the physicians to know that delirium has a similar – if not larger – impact on the clinical outcome of their patient,” Kwak said.

There are currently no proven medications to cure delirium. To help address this issue, Kwak suggests clinical practices adapt to strategies proven to prevent delirium.

These strategies include Hospital Elder Life Program, ABCDEF Bundle, and Age-Friendly Health Systems, which focuses on patient-centered multicomponent care planning. For example, the Age-Friendly Health Systems initiative by the Institute for Healthcare Improvement focuses on “4Ms” of quality care: medication, mentation, mobility, and what matters.

“I propose the use of these strategies to help prevent, reduce, manage delirium. These approaches were created to use multidisciplinary teams to put the patient in the center of care. Delirium management takes a multicomponent effort,” Kwak said. “This includes engaging with the patient, their family members, and using other methods like providing hearing amplifiers or reading glasses to help maximize their perceptions. Doing these tasks can really help with management and we hope it will help decrease the mortality rate.”

Kwak and her team with UTHealth and UT Physicians, the clinical practice of McGovern Medical School, currently implement the Age-Friendly Health System in their everyday practice. Kwak has been leading Age-Friendly Health Systems initiative at Memorial Hermann Hospital Cardiac Intensive Care Unit and Cardiac Intermediate Care Unit to reduce delirium incidence. They were recognized as “Committed to Care Excellence” by Institute for Healthcare Improvement.

Additional authors with UT Physicians and McGovern Medical School include Holly M. Holmes, MD, MS, associate professor and director of geriatric and palliative medicine; Rachel Jantea, MD, MS, assistant professor of geriatric and palliative medicine; Renee Flores, MD, associate professor of geriatric and palliative medicine; Nahid Rianon, MD, DrPH, associate professor of geriatric and palliative medicine; Abhijeet Dhoble, MD, MPH, associate professor of cardiovascular medicine; Elenir Avritscher, MD, PhD, MBA/MHA, associate professor of pediatrics; and Tong Han Chung, PhD, health economist at Healthcare Transformation Initiatives with UT Physicians.

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