Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis
Abstract Background Transcatheter aortic valve replacement is increasingly performed in frail older patients who were previously ineligible for a standard surgical procedure. The objectives of this study are to determine delirium incidence, predictors, and relationship with cognitive performance at...
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| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-021-02100-5 |
| _version_ | 1819160100795842560 |
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| author | Marc Humbert Christophe J. Büla Olivier Muller Hélène Krief Pierre Monney |
| author_facet | Marc Humbert Christophe J. Büla Olivier Muller Hélène Krief Pierre Monney |
| author_sort | Marc Humbert |
| collection | DOAJ |
| description | Abstract Background Transcatheter aortic valve replacement is increasingly performed in frail older patients who were previously ineligible for a standard surgical procedure. The objectives of this study are to determine delirium incidence, predictors, and relationship with cognitive performance at 3-month follow-up in older patients undergoing aortic valve replacement (AVR). Methods Patients (N = 93) aged 70 years and older, undergoing transcatheter (TAVR, N = 66) or surgical (SAVR, N = 27) aortic valve replacement in an academic medical center were enrolled in this prospective cohort study. Delirium was assessed using the Confusion Assessment Method (CAM) on postoperative days 1, 2, 3, and 7. Data on patients’ socio-demographics, functional status (including instrumental activities of daily living (IADL), and surgical risk scores (including Society of Thoracic Surgeons (STS) risk score), were collected at baseline. Cognitive status was assessed with the Mini-Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) at baseline and 3 months after AVR. Results Delirium occurred in 21 (23%) patients, within the first three postoperative days in 95% (20/21) of the cases. Delirium incidence was lower in TAVR (13/66 = 20%) than SAVR (8/27 = 30%) patients, but this difference was not statistically significant (p = .298). Patients with delirium had lower baseline cognitive performance (median MMSE score 27.0 ± 3.0 vs 28.0 ± 3.0, p = .029), lower performance in IADL (7.0 vs 8.0, p = .038), and higher STS risk scores (4.7 ± 2.7 vs 2.9 ± 2.3, p = .020). In multivariate analyses, patients with intermediate (score > 3 to ≤8) and high (score > 8) STS risk scores had 4.3 (95%CI 1.2–15.1, p = .025) and 16.5 (95%CI 2.0–138.2, p = .010), respectively, higher odds of incident delirium compared to patients with low (score ≤ 3) STS risk scores. At 3-month follow-up (N = 77), patients with delirium still had lower MMSE score (27.0 ± 8.0 vs 28.0 ± 2.0, p = .007) but this difference did not remain significant once adjusting for baseline MMSE (β-coefficient 1.11, 95%CI [− 3.03–0.80], p = .248). Conclusions Delirium occurred in about one in five older patients undergoing AVR, almost essentially within the first three postoperative days. Beside cognitive performance, STS risk score could enhance the identification of high-risk older patients to better target preventative interventions. |
| first_indexed | 2024-12-22T16:51:05Z |
| format | Article |
| id | doaj.art-80c2ea3b2021450d8dee5efb8237ed19 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-22T16:51:05Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
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| series | BMC Geriatrics |
| spelling | doaj.art-80c2ea3b2021450d8dee5efb8237ed192022-12-21T18:19:36ZengBMCBMC Geriatrics1471-23182021-03-012111910.1186/s12877-021-02100-5Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosisMarc Humbert0Christophe J. Büla1Olivier Muller2Hélène Krief3Pierre Monney4Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV)Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV)Service of Cardiology, Department of Cardio-Vascular Medicine and Surgery, University of Lausanne Medical Center (CHUV)Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV)Service of Cardiology, Department of Cardio-Vascular Medicine and Surgery, University of Lausanne Medical Center (CHUV)Abstract Background Transcatheter aortic valve replacement is increasingly performed in frail older patients who were previously ineligible for a standard surgical procedure. The objectives of this study are to determine delirium incidence, predictors, and relationship with cognitive performance at 3-month follow-up in older patients undergoing aortic valve replacement (AVR). Methods Patients (N = 93) aged 70 years and older, undergoing transcatheter (TAVR, N = 66) or surgical (SAVR, N = 27) aortic valve replacement in an academic medical center were enrolled in this prospective cohort study. Delirium was assessed using the Confusion Assessment Method (CAM) on postoperative days 1, 2, 3, and 7. Data on patients’ socio-demographics, functional status (including instrumental activities of daily living (IADL), and surgical risk scores (including Society of Thoracic Surgeons (STS) risk score), were collected at baseline. Cognitive status was assessed with the Mini-Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) at baseline and 3 months after AVR. Results Delirium occurred in 21 (23%) patients, within the first three postoperative days in 95% (20/21) of the cases. Delirium incidence was lower in TAVR (13/66 = 20%) than SAVR (8/27 = 30%) patients, but this difference was not statistically significant (p = .298). Patients with delirium had lower baseline cognitive performance (median MMSE score 27.0 ± 3.0 vs 28.0 ± 3.0, p = .029), lower performance in IADL (7.0 vs 8.0, p = .038), and higher STS risk scores (4.7 ± 2.7 vs 2.9 ± 2.3, p = .020). In multivariate analyses, patients with intermediate (score > 3 to ≤8) and high (score > 8) STS risk scores had 4.3 (95%CI 1.2–15.1, p = .025) and 16.5 (95%CI 2.0–138.2, p = .010), respectively, higher odds of incident delirium compared to patients with low (score ≤ 3) STS risk scores. At 3-month follow-up (N = 77), patients with delirium still had lower MMSE score (27.0 ± 8.0 vs 28.0 ± 2.0, p = .007) but this difference did not remain significant once adjusting for baseline MMSE (β-coefficient 1.11, 95%CI [− 3.03–0.80], p = .248). Conclusions Delirium occurred in about one in five older patients undergoing AVR, almost essentially within the first three postoperative days. Beside cognitive performance, STS risk score could enhance the identification of high-risk older patients to better target preventative interventions.https://doi.org/10.1186/s12877-021-02100-5Aortic stenosisDeliriumTranscatheter aortic valve replacementSurgical aortic valve replacementSociety of thoracic surgeons risk score |
| spellingShingle | Marc Humbert Christophe J. Büla Olivier Muller Hélène Krief Pierre Monney Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis BMC Geriatrics Aortic stenosis Delirium Transcatheter aortic valve replacement Surgical aortic valve replacement Society of thoracic surgeons risk score |
| title | Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis |
| title_full | Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis |
| title_fullStr | Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis |
| title_full_unstemmed | Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis |
| title_short | Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis |
| title_sort | delirium in older patients undergoing aortic valve replacement incidence predictors and cognitive prognosis |
| topic | Aortic stenosis Delirium Transcatheter aortic valve replacement Surgical aortic valve replacement Society of thoracic surgeons risk score |
| url | https://doi.org/10.1186/s12877-021-02100-5 |
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