Open AccessIncidence, determinants and consequences of delirium in older patients after transcatheter aortic valve implantation
Author(s) -
Jeannette A. Goudzwaard,
Marjo J A G de Ronde-Tillmans,
Tom Jager,
Mattie Lenzen,
RutgerJan Nuis,
Nicolás M. Van Mieghem,
Joost Daemen,
Peter P.T. de Jaegere,
Francesco Mattace-Raso
Publication year - 2020
Publication title -
age and ageing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.014
H-Index - 143
eISSN - 1468-2834
pISSN - 0002-0729
DOI - 10.1093/ageing/afaa001
Subject(s) - medicine , delirium , incidence (geometry) , odds ratio , stroke (engine) , surgery , intensive care medicine , mechanical engineering , physics , optics , engineering
Background delirium is an event leading to negative health outcomes and increased mortality in patients. The aim of this study is to investigate the incidence, determinants and consequences of post-operative delirium (POD) in older patients undergoing transcatheter aortic valve implantation (TAVI). Methods The TAVI Care and Cure program is a prospective, observational registry in patients referred for TAVI at Erasmus University Medical Centre. The presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and up to 3 days post-TAVI. Mortality data were obtained from the Dutch Civil Registry. Results A total of 543 patients underwent TAVI between January 2014 and December 2017. Overall, the incidence of POD was 14% (75/543 patients) but declined from 18% in 2014 to 7% in 2017 (P = 0.009). Patients who developed POD were older (81.9 ± 5.8 versus 78.6 ± 8.3 years, P < 0.001), had higher prevalence of renal dysfunction and prior stroke (54% versus 40%, P = 0.02; 31% versus 18%, P = 0.01) and were more often frail (32% versus 25%, P = 0.02). From a procedural perspective, general anesthesia (odds ratios (OR), 2.31; 95% CI, 1.40–3.83; P = 0.001), non-transfemoral access (OR, 2.37; 95% CI, 1.20–4.70; P = 0.01) and longer procedural time (OR, 1.01; 95% CI, 1.01–1.02; P < 0.001) were significantly associated with POD. One-year survival rate was 68% among patients who had suffered a POD and was 85% in patients without a POD (hazard ratio’s 1.8 (95% CI 1.01–3.10), P = 0.045). Conclusion POD frequently occurs after TAVI and is associated with increased mortality. It might be speculated that patient selection and the minimalistic approach of TAVI may reduce the frequency of delirium.