title: Editor's Choice-Clinical impact of delirium and antipsychotic therapy: 10-Year experience from a referral coronary care unit.
abstract: BACKGROUND
  Little is known about safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients.
  
  
  RESULTS
  Pre-study Confusion Assessment Method-Intensive Care Unit (CAM-ICU) criteria were implemented in screening consecutive patients admitted to a referral CCU from 2004-2013. Death status was prospectively ascertained. Of 11,079 study patients, the incidence of delirium was 8.3% ( n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted odds ratio (OR) 1.49; 95% confidence interval (CI), 1.08-2.08; p=0.02) and one-year mortality among patients who survived from CCU admission (adjusted hazard ratio (HR) 1.46; 95% CI, 1.12-1.87; p=0.005). A total of 792 doses of haloperidol (5 mg/day; interquartile range (IQR) 3-10) or quetiapine (25 mg/day; IQR 13-50) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT (QTc) interval 457±58 ms vs 459±60 ms, respectively; p=0.65). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57 and 450±50 ms, respectively) or quetiapine groups (470±66, 467±68 and 462±46 ms, respectively) ( p>0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42-1.04; p=0.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17-3.62; p=0.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62-1.17; p=0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics.
  
  
  CONCLUSIONS
  In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.
authors.affiliation: 1 Division of Cardiovascular Diseases, Mayo Clinic, USA.
authors.forename: Niyada
authors.initials: N
authors.lastname: Naksuk
authors.affiliation: 2 Department of Anesthesiology, Mayo Clinic, USA.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: 1 Division of Cardiovascular Diseases, Mayo Clinic, USA.
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Park
authors.affiliation: 3 Division of Hospital Internal Medicine, Mayo Clinic, USA.
authors.forename: Sunita
authors.initials: S
authors.lastname: Sharma
authors.affiliation: 4 Mayo Medical School, Mayo Clinic College of Medicine, USA.
authors.forename: Prakriti
authors.initials: P
authors.lastname: Gaba
authors.affiliation: 5 Department of Internal Medicine, Mayo Clinic, USA.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Rosenbaum
authors.affiliation: 6 Department of Internal Medicine, University of Minnesota, USA.
authors.forename: Thoetchai
authors.initials: T
authors.lastname: Peeraphatdit
authors.affiliation: 4 Mayo Medical School, Mayo Clinic College of Medicine, USA.
authors.forename: Tiffany Y
authors.initials: TY
authors.lastname: Hu
authors.affiliation: 1 Division of Cardiovascular Diseases, Mayo Clinic, USA.
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Bell
authors.affiliation: 2 Department of Anesthesiology, Mayo Clinic, USA.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.affiliation: 1 Division of Cardiovascular Diseases, Mayo Clinic, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brady
authors.affiliation: 1 Division of Cardiovascular Diseases, Mayo Clinic, USA.
authors.forename: Suraj
authors.initials: S
authors.lastname: Kapa
authors.affiliation: 1 Division of Cardiovascular Diseases, Mayo Clinic, USA.|7 Department of Pediatrics and Adolescent Medicine, Mayo Clinic, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003325:Coronary Care Units; D003693:Delirium / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D005544:Forecasting; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D017202:Myocardial Ischemia / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents
keywords: Arrhythmias; QTc interval; haloperidol; mortality; quetiapine