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Delirium may occur in older patients after TAVR
Delirium was experienced in 23% of patients older than 60 years who underwent elective transcatheter aortic valve replacement for the treatment of aortic stenosis, according to a systematic review published in The American Journal of Cardiology.
Erica Tilley, PhD candidate in the Cognitive Aging and Impairment Neurosciences Lab at University of South Australia in Adelaide, and colleagues analyzed data from nine studies on patients who underwent TAVR that were published between 2002 and Feb. 12, 2017. The studies included were not adequately powered to identify the prevalence of delirium, according to the authors.
The primary outcome was the prevalence of delirium, which was identified with standardized methods such as the Diagnostic and Statistical Manual of Mental Disorders-IV or the Confusion Assessment Method.
Studies that assessed for delirium for a minimum of 3 consecutive days after TAVR had a pooled prevalence of delirium of 24.9% (95% CI, 19.1-31.6). The pooled prevalence of delirium in studies that did not assess for it daily during the 3 days after TAVR was 2% (95% CI, 0.4-8.9).
Among comorbidities, the presence of CAD had the greatest effect on delirium vs. no delirium (OR = 4; 95% CI, 2.17-8.68), whereas cognitive impairment, atrial fibrillation, peripheral artery disease, hypertension and prior stroke/transient ischemic attack all had a minimal effect on delirium.
Periprocedural factors that were significantly linked to delirium after TAVR included the transapical approach (OR = 4; 95% CI, 2.25-8.98) and acute kidney injury (OR = 5; 95% CI, 2.24-9.74).
“Proven delirium preventative measures should be considered as part of post-procedural care for patients undergoing transapical approach TAVI with a history of carotid artery disease, cognitive impairment, atrial fibrillation, stroke/TIA, peripheral artery disease and hypertension,” Tilley and colleagues wrote. “Where possible, acute kidney injury should be prevented in patients undergoing TAVI, as this is a modifiable risk factor for the development of delirium.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.