The accuracy of delirium assessment by cardiologists treating heart failure inpatients: a single center retrospective survey

Abstract

Background: Patients with heart failure (HF) accompanied by delirium are at risk of rehospitalization and death, thus early detection and appropriate treatment is imperative. Palliative care for patients with HF is an important issue, particularly for patients who also have delirium. This retrospective study examined the accuracy of delirium assessment by cardiologists treating patients with HF, identified factors related to the detection of delirium, and recorded the initial treatment. Methods: This was a retrospective chart survey of 165 patients with HF referred to a consultation liaison (C-L) service during treatment in the cardiology wards of a general hospital over a 6-year period. Diagnosis of delirium by the C-L psychiatrists was based on DSM-IV-TR. Cases in which cardiologists had stated "delirium" in the medical records were classified as an accurate assessment of delirium (Agreement group). Cases in which cardiologists did not state "delirium" were classified as Disagreement. Results: Among 81 patients with delirium (51 [62.9%] male; 74.7 ± 13.3 years old), the ratio of accurate assessment of delirium by cardiologists was 50.6% (n = 41; Agreement group). Age, sex, and HF severity did not differ significantly between the two groups. Although disquietedness was identified most frequently (n = 59, 73%), only 33 of these 59 patients (55.9%) were recognized as having delirium by cardiologists. Inappropriate initial treatments were only noted in the Disagreement group. In both groups, most cases were referred to a C-L service without new medication for psychiatric symptoms. Conclusions: An accurate assessment of the delirium of inpatients with HF by cardiologists was found in only around half of all cases. Accurate detection is important to avoid harmful drug administration and to provide appropriate palliative care.

Diagnostic Agreement between Physicians and a Consultation–Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals

“…The high rates of referrals for delirium are in line with previous evidence that indicates an overall aging of the inpatient population in GHs and reveal a high incidence of delirium in the inpatient setting [ 35 , 36 ], a common reason for psychiatric referral [ 22 , 24 , 37 ]. The fair diagnostic accuracy found for delirium (which rose to moderate when the presentation was associated with agitation) indicates a remarkable and well-known risk that GH doctors may miss a delirium diagnosis [ 36 , 38 ], particularly in case of hypo-active delirium [ 39 ]. Further, the diagnostic concordance for delirium was lower in patients with a positive psychiatric history, suggesting that this fact may mislead the GH doctors and make them more likely to attribute symptoms of delirium to a previous psychiatric condition, preventing a proper recognition of the syndrome.…”

Impact of delirium on mortality in patients hospitalized for heart failure

“…22,25,26 This is most likely a result of under-recognition, underdiagnosis and underreporting of delirium which is a common pitfall. 27–30 In one single center study of patients admitted to the medical intensive care unit (ICU), the prevalence of delirium on retrospective chart review was 1.7% whereas it was almost 60% on prospective evaluation using structured and validated tools such as Confusion Assessment Method–Intensive Care Unit (CAM–ICU). 29 There are several potential reasons for this under diagnosis including lack of provider knowledge, inadequate dissemination of published guidelines, and time constraints in following recommended practices.…”

“…22,25,26 This is most likely a result of under-recognition, underdiagnosis and underreporting of delirium which is a common pitfall. [27][28][29][30] In one single center study of patients admitted to the Note. For all ratios, values above 1 are indicative of higher outcome values for hospitalizations that included a delirium diagnosis.…”

Delirium detection using GAMMA wave and machine learning: A pilot study

“…The Confusion Assessment Method for the ICU (CAM‐ICU) is recommended by the Society of Critical Care Medicine, has been extensively studied for more than 20 years and demonstrates good psychometric properties in critically ill patients when performed by researchers (Chanques et al, 2017; Devlin et al, 2018). Although the CAM‐ICU has poor accuracy when used by clinicians, when used by researchers, sensitivity and specificity were 93% and 98%, respectively (DiLibero et al, 2016; Hayashi et al, 2020).…”