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

Chetan P. Huded, Jill M. Huded, Ranya Nabil Sweis, Mark J Ricciardi, S Chris Malaisrie, Charles J Davidson, James D Flaherty*

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1286-1291
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume89
Issue number7
DOIs
StatePublished - Jun 1 2017

Fingerprint

Delirium
Delivery of Health Care
Survival
Aortic Valve
Catheters
Mortality
Transcatheter Aortic Valve Replacement
Confusion
Tertiary Healthcare
Length of Stay
Rehabilitation
Confidence Intervals
Morbidity

Keywords

  • aged
  • aging
  • aortic valve stenosis
  • cognition
  • transcatheter aortic valve intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{450ae44deccf4d599ecac8715f8b5203,
title = "The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement",
abstract = "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.",
keywords = "aged, aging, aortic valve stenosis, cognition, transcatheter aortic valve intervention",
author = "Huded, {Chetan P.} and Huded, {Jill M.} and Sweis, {Ranya Nabil} and Ricciardi, {Mark J} and Malaisrie, {S Chris} and Davidson, {Charles J} and Flaherty, {James D}",
year = "2017",
month = "6",
day = "1",
doi = "10.1002/ccd.26776",
language = "English (US)",
volume = "89",
pages = "1286--1291",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",
number = "7",

}

TY - JOUR

T1 - The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement

AU - Huded, Chetan P.

AU - Huded, Jill M.

AU - Sweis, Ranya Nabil

AU - Ricciardi, Mark J

AU - Malaisrie, S Chris

AU - Davidson, Charles J

AU - Flaherty, James D

PY - 2017/6/1

Y1 - 2017/6/1

N2 - 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.

AB - 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.

KW - aged

KW - aging

KW - aortic valve stenosis

KW - cognition

KW - transcatheter aortic valve intervention

UR - http://www.scopus.com/inward/record.url?scp=84983479533&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84983479533&partnerID=8YFLogxK

U2 - 10.1002/ccd.26776

DO - 10.1002/ccd.26776

M3 - Article

C2 - 27566989

AN - SCOPUS:84983479533

VL - 89

SP - 1286

EP - 1291

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 7

ER -