Demand Ischemia as a Predictor of Mortality in Older Patients With Delirium

Manish Kumar; Shivaraj Patil; Lucas Da Cunha Godoy; Chia-Ling Kuo; Helen Swede; George A Kuchel; Kai Chen

doi:10.3389/fcvm.2022.917252

Demand Ischemia as a Predictor of Mortality in Older Patients With Delirium

Front Cardiovasc Med. 2022 Jun 6:9:917252. doi: 10.3389/fcvm.2022.917252. eCollection 2022.

Authors

Manish Kumar¹, Shivaraj Patil², Lucas Da Cunha Godoy³, Chia-Ling Kuo^{3

4

5}, Helen Swede⁴, George A Kuchel⁵, Kai Chen¹

Affiliations

¹ Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut, Farmington, CT, United States.
² Department of Internal Medicine, University of Connecticut, Farmington, CT, United States.
³ Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT, United States.
⁴ Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States.
⁵ UConn Center of Aging, University of Connecticut School of Medicine, Farmington, CT, United States.

Abstract

Introduction: The impact of demand ischemia on clinical outcomes in patients with delirium remains largely unexplored. This study aims to evaluate the effects of demand ischemia in older patients with delirium on in-hospital mortality and length of stay (LOS) using the largest US inpatient care database, National Inpatient Sample (NIS).

Methods: We obtained data from the year 2010 to 2014 National Inpatient Sample (NIS). We used the International Classification of Diseases-Ninth Edition-Clinical Modification (ICD-9-CM) diagnosis codes to identify all the records with a primary or secondary diagnosis of delirium with or without demand ischemia and other clinical characteristics. We then compared in-hospital mortality and length of stay (LOS) in patients with and without demand ischemia.

Results: We analyzed 232,137 records. Patients with demand ischemia had higher overall in-hospital mortality than those without demand ischemia (28 vs. 12%, p < 0.001). After adjusting for clinical comorbidities and complications, demand ischemia was no longer associated with increased in-hospital mortality (OR: 1.14; 95% CI: 0.96-1.35; p = 0.141). However, further analysis with the exclusion of critically ill patients with non-cardiogenic shock or mechanical ventilation showed a significant association of demand ischemia with increased in-hospital mortality (adjusted OR: 1.39; 95% CI: 1.13-1.71; p = 0.002). Among non-critically ill survivors, patients with demand ischemia had a longer median LOS [4, (3-7) days] than those without demand ischemia [4, (2-6) days] (p < 0.001). However, the difference was not statistically significant after adjustment for covariates.

Conclusion/relevance: Demand ischemia did not affect mortality in critically sick patients. In non-critically ill patients, however, demand ischemia was significantly associated with increased in-hospital mortality, likely due to the severity of the underlying acute illness. Measures aimed at mitigating risk factors that contribute to delirium and/or demand ischemia need to be explored.

Keywords: clinical outcomes; coronary artery disease; delirium; demand ischemia; mortality.