Nawal Salahuddin, MBBS, FCCP
Professor
National Institutes of Cardiovascular Diseases Karachi.
Karachi, Pakistan
Disclosure information not submitted.
Lalarukh Taimoor, MBBS, FCPS
Doctor
National Institutes of Cardiovascular Diseases Karachi.
Karachi, Pakistan
Disclosure information not submitted.
Urwah Ikhlaq, MBBS, FCPS
Doctor
National Institutes of Cardiovascular Diseases Karachi.
Karachi, Pakistan
Disclosure information not submitted.
Arsalan Younus, MBBS
Doctor
National Institutes of Cardiovascular Diseases Karachi.
Karachi, Pakistan
Disclosure information not submitted.
Komal Baloch, MBBS, FCPS
Doctor
National Institutes of Cardiovascular Diseases Karachi.
Karachi, Pakistan
Disclosure information not submitted.
Abdul Hameed Ali Ahmed, MBBS
Doctor
National Institutes of Cardiovascular Diseases Karachi.
Karachi, Pakistan
Disclosure information not submitted.
Maheen Wahaj, MBBS, FCPS
Doctor
National Institutes of Cardiovascular Diseases Karachi.
Karachi, Pakistan
Disclosure information not submitted.
Jawed Warind, MBBS, FCCP
Professor
National Institutes of Cardiovascular Diseases Karachi.
Karachi, Pakistan
Disclosure information not submitted.
Title: Delirium After Acute Coronary Syndrome: A Missed Opportunity
Introduction: Delirium has been described as a risk factor for increased mortality and longer stays in the Intensive Care Unit (ICU). There is insufficient information regarding delirium in patients after Acute Coronary Syndrome admitted to the ICU. The objective of this study was to determine the prevalence and the frequency of subtypes (hypoactive and hyperactive) of delirium, identify an at risk phenotype and compute outcomes.
Methods: Consecutive, adult patients admitted to the Cardiac ICU after Acute Coronary Syndromes were assessed for Delirium using the CAM-ICU tool. Baseline characteristics, risk factors and outcomes were noted. Data was analyzed using the SPSS version 26.0.
Results: 201 patients were enrolled. 51.2% (104) had ST elevation MI, 48% (97) had Non ST elevation MI. 45.3% (92) were in shock and 10.3% (21) had an IABP in place. Angioplasty was performed in 82.3% (167). 34.5% (71) patients were identified with Delirium; 46.4% (33) had hypoactive delirium and 53.5% (38) had hyperactive delirium. On multivariate regression, independent predictors of delirium were; Sepsis, HR 3.4 (95% CI: 1.38, 8.8, p 0.012), Uremia HR 5.07 (95% CI: 2.0, 12.4, p < 0.001), Mechanical Ventilation HR 10.9 (95% CI: 4.2, 28.3, p < 0.001), Non-invasive Ventilation HR 5.75 (95% CI: 2.2, 14.7, p < 0.001), IABP HR 9.15 (95% CI: 1.6, 51.8, p 0.012). <span style="mso-spacerun: yes;"> On multivariate regression, delirium was an independent risk for mortality; HR 7.6(95% CI 3.1, 18.5, p < 0.001). Mean ICU stay in patients with delirium was 7.8 ± 2.36 days, as compared to patients without delirium, 4.55 ± 1.45 days, p< 0.001. Overall mortality was 17.4% (35); 13.4%(27) in patients with delirium and 4%(8) in patients without delirium, p< 0.001.
Conclusion: Delirium is a common occurrence in the Cardiac ICU, with hypoactive as common as the hyperactive type. Sicker patients and those on assisted ventilation appear to be at higher risk. The high attributable mortality mandates routine screening for delirium in these patients.