Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study

Paul Noufi; Kelley M Anderson; Nancy Crowell; Yasmine White; Ezequiel Molina; Sriram D Rao; Hunter Groninger

doi:10.1016/j.jaclp.2024.04.005

Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study

J Acad Consult Liaison Psychiatry. 2024 May 3:S2667-2960(24)00048-X. doi: 10.1016/j.jaclp.2024.04.005. Online ahead of print.

Authors

Paul Noufi¹, Kelley M Anderson², Nancy Crowell², Yasmine White³, Ezequiel Molina⁴, Sriram D Rao⁴, Hunter Groninger⁵

Affiliations

¹ Palliative Care, MedStar Harbor Hospital, Baltimore, MD; Georgetown University School of Medicine, Washington, DC. Electronic address: paul.noufi@medstar.net.
² Georgetown University School of Nursing, Washington, DC.
³ Georgetown University School of Medicine, Washington, DC.
⁴ MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC.
⁵ Georgetown University School of Medicine, Washington, DC; Palliative Care, MedStar Washington Hospital Center, Washington, DC.

PMID: 38705515
DOI: 10.1016/j.jaclp.2024.04.005

Abstract

Background: In critically ill patients, delirium is a prognostic indicator of morbidity and mortality.

Objective: This study investigates the impact of a delirium diagnosis on outcomes after left ventricular assist device (LVAD) implantation.

Methods: This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared preimplantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as reintubation rate, length of stay, discharge disposition, and readmission rates.

Results: In total, 361 patients (26.7% women and 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Preimplantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P = 0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P = 0.007), 6-month (P = 0.004), and in-hospital mortality (P < 0.001), unplanned reintubations (P < 0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and intensive care unit length of stay were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to the hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant.

Conclusions: In this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse postsurgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.

Keywords: LVAD; delirium; morbidity; mortality.