The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement

• Published in: Catheterization and cardiovascular interventions Vol. 89; no. 7; pp. 1286 - 1291
• Main Authors: Huded, Chetan P., Huded, Jill M., Sweis, Ranya N., Ricciardi, Mark J., Malaisrie, S. Chris, Davidson, Charles J., Flaherty, James D.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.06.2017
• Subjects: Aged; Aged, 80 and over; aging; Aortic valve; aortic valve stenosis; Catheters; cognition; Delirium; Delirium - diagnosis; Delirium - etiology; Delirium - mortality; Delirium - therapy; Female; Femur; Health care facilities; Health Resources - statistics & numerical data; Health services utilization; Humans; Length of Stay; Male; Medical instruments; Medical personnel; Mental disorders; Morbidity; Mortality; Older people; Patient Discharge; Proportional Hazards Models; Rehabilitation; Rehabilitation Centers; Retrospective Studies; Risk Factors; Risk groups; Surgeons; Survival; Tertiary Care Centers; Thorax; Time Factors; transcatheter aortic valve intervention; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; aged; aortic valve stenosis; transcatheter aortic valve intervention; aging; cognition
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26776

Objectives We assessed whether post‐operative delirium is associated with healthcare utilization and overall survival after trans‐catheter aortic valve replacement. Background Delirium, a common syndrome among hospitalized older adults, is associated with increased morbidity and mortality. Methods We reviewed 294 transcatheter aortic valve replacement cases between June 2008 and February 2015 at a tertiary care academic medical center. Post‐operative delirium was identified by confusion assessment method screening and clinician diagnosis. Results Delirium was identified in 61 patients (21%). Non‐femoral access for trans‐catheter aortic valve replacement was more common in delirious patients than in non‐delirious patients (41% vs. 27%, P = 0.04). Delirious patients had diminished overall survival after trans‐catheter aortic valve replacement compared to non‐delirious patients (1‐year survival 59% vs. 84%, log‐rank P = 0.002). After adjusting for age, Society of Thoracic Surgeons predicted 30‐day mortality, and access type; delirium remained independently associated with diminished overall survival (hazard ratio 2.01, 95% confidence interval 1.21–3.33, P = 0.007). The delirium group had longer mean hospital stay (13.3 ± 9.5 days vs. 6.7 ± 3.8 days, P < 0.001) and a higher rate of discharge to a rehabilitation facility (61% vs. 27%, P < 0.001), but there was no difference in 30‐day hospital re‐admission rates or 30‐day mortality based on delirium status. Conclusions Delirium occurs in one out of five patients after trans‐catheter aortic valve replacement and is associated with diminished survival and increased healthcare utilization. Further studies are needed to clarify whether strategies aimed at reducing delirium after trans‐catheter aortic valve replacement may improve outcomes in this high‐risk subset. © 2016 Wiley Periodicals, Inc.