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Delirium Among Adults Undergoing Transcatheter Structural Heart Intervention: Incidence, Risk, and Clinical
Yasser Jamil1, Nadim Jaafar2, Armin Nouri3
1Inova Schar Heart and Vascular Institute, Falls Church, Virginia, USA.
Summary
Delirium is a common complication after transcatheter heart procedures, increasing mortality and costs. Identifying high-risk patients and implementing prevention strategies are crucial for better outcomes.
Area of Science:
- Geriatric Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- Delirium is an underrecognized complication following transcatheter structural heart interventions.
- Limited data exist on delirium incidence and outcomes across various structural heart procedures.
- The association between delirium and clinical outcomes after these interventions remains uncertain.
Purpose of the Study:
- To determine the incidence of delirium after transcatheter aortic valve replacement (TAVR), transcatheter edge-to-edge mitral repair (TEER), transcatheter tricuspid valve replacement/repair (TTVR), and left atrial appendage occlusion (LAAO).
- To identify predictors of delirium in patients undergoing these procedures.
- To evaluate the in-hospital outcomes associated with delirium after transcatheter structural heart interventions.
Main Methods:
- Retrospective analysis of adult patients undergoing TAVR, TEER, TTVR, or LAAO using the National Inpatient Sample.
- Delirium identification through validated diagnostic codes.
- Multivariable logistic and linear regression models were used to assess predictors and outcomes, adjusting for relevant covariates.
Main Results:
- Delirium incidence varied across procedures: 2.8% (TAVR), 4.0% (TEER), 4.4% (TTVR), and 0.6% (LAAO) among 151,455 hospitalizations.
- Delirium was independently associated with increased in-hospital mortality (aORs ranging from 2.7 to 27.7), mechanical ventilation, cardiac arrest, longer length of stay, and higher costs.
- Strongest delirium predictors included geriatric-specific conditions like frailty, dementia, malnutrition, and high comorbidity burden.
Conclusions:
- Delirium following transcatheter structural heart interventions is linked to significantly adverse clinical outcomes and increased resource utilization.
- These findings highlight the critical need for delirium risk stratification and targeted prevention strategies within structural heart intervention pathways.
- Implementing such strategies is essential to maximize the net clinical benefit of these life-saving procedures.
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