title: Prognostic value and risk factors of delirium in emergency patients with decompensated heart failure.
abstract: OBJECTIVE
  Patients with heart failure (HF) seen at the emergency department (ED) are increasingly older and more likely to present delirium. Little is known, however, about the impact of this syndrome on outcome in these patients. We aimed to investigate the prognostic value and risk factors of delirium at admission (prevalent delirium) in ED patients with decompensated HF.
  
  
  RESULTS
  We performed a prospective, observational study, analyzing the presence of prevalent delirium in decompensated HF patients attended at the ED in 2 hospitals in Spain in the context of the Epidemiology Acute Heart Failure Emergency project. We used the brief Confusion Assessment Method to assess the presence of delirium. Patients were followed for 1 month after discharge. Of 239 enrolled patients (81.7 ± 9.4 years, women 61.1%, long-term care [LTC] 11%), 35 (14.6%) had prevalent delirium (20% LTC vs 9.4% in-home, P = .078). The factors associated with delirium in the multivariate analysis were functional dependence (P = .001) and dementia (P = .005). Prevalent delirium was an independent risk factor of death within 30 days (OR 3.532; 95% CI 1.422-8.769, P = .007) whereas autonomy in basic activities of daily living was a protective factor (OR 0.971; 95% CI 0.956-0.986, P = .001). The area under the ROC curve for our 30-day mortality model was 0.802 (95% CI 0.721-0.883, P = .001).
  
  
  CONCLUSIONS
  Prevalent delirium in patients with decompensated HF was a predictor of short-term mortality. Routine identification of delirium in patients at risk, particularly those with greater functional dependence, can help emergency physicians in decision-making and enhance care in patients with decompensated HF.
authors.affiliation: Emergency Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Spain; Representing the members of the ICA-SEMES group/EAHFE-3 Project; Medicine Department, Universidad Autónoma de Barcelona, Spain. Electronic address: mrizzi@santpau.cat.
authors.forename: Miguel Alberto
authors.initials: MA
authors.lastname: Rizzi
authors.affiliation: Medicine Department, Universidad Autónoma de Barcelona, Spain; Department of Geriatrics, Internal Medicine Service, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Spain.
authors.forename: Olga Herminia
authors.initials: OH
authors.lastname: Torres Bonafonte
authors.affiliation: Emergency Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Spain; Representing the members of the ICA-SEMES group/EAHFE-3 Project; Medicine Department, Universidad Autónoma de Barcelona, Spain.
authors.forename: Aitor
authors.initials: A
authors.lastname: Alquezar
authors.affiliation: Emergency Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Herrera Mateo
authors.affiliation: Representing the members of the ICA-SEMES group/EAHFE-3 Project; Emergency Department, Hospital Reina Sofia, Murcia, Spain.
authors.forename: Pascual
authors.initials: P
authors.lastname: Piñera
authors.affiliation: Emergency Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Spain; Medicine Department, Universidad Autónoma de Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Puig
authors.affiliation: Emergency Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Spain; Medicine Department, Universidad Autónoma de Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Benito
authors.affiliation: Medicine Department, Universidad Autónoma de Barcelona, Spain; Department of Geriatrics, Internal Medicine Service, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Ruiz
mesh_terms: D000368:Aged; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: Delirium; comprehensive geriatric assessment; emergency department; heart failure