Delirium, characterized by sudden confusion, disorientation, impaired attention, and altered perception, is a common but often underestimated complication in cardiology. According to a recent international review involving experts from various medical fields, delirium after cardiac procedures can have serious long-term consequences for patients.
The review found that older patients who undergo cardiac surgery or interventional procedures are particularly at risk. Delirium is linked to longer hospital and intensive care stays, increased mortality rates, greater dependency on care, and a higher likelihood of permanent cognitive impairment. It is also an independent predictor of long-term mental decline, even among those who were previously cognitively healthy.
The prevalence of delirium varies depending on the type of procedure and assessment methods used. Complex surgeries as well as less invasive interventions such as transcatheter aortic valve replacement (TAVR) or percutaneous coronary intervention (PCI) pose significant risks for elderly or pre-existing patients. Prof. Dr. Dr. Enzo Lüsebrink, co-last author of the study and cardiologist in Bonn, along with Prof. Dr. Georg Nickenig from the Clinic for Cardiology at UKB, emphasized: "Delirium is not a marginal problem, but one of the central complications of modern cardiac medicine."
Despite its significance, delirium frequently goes unrecognized in cardiovascular practice—especially its hypoactive form which presents with apathy and reduced activity and may be mistaken for age-related changes or exhaustion. Co-first author Endrit Cekaj from the Clinic for Cardiology at UKB noted: "Validated and standardized screening instruments such as the Confusion Assessment Method, or CAM for short, with the corresponding extension for intensive care units, which can be used quickly and reliably, are still far too rarely used routinely in everyday clinical practice."
The review highlights prevention as the most effective strategy against delirium. Non-drug measures like early mobilization, reorientation efforts, maintaining sleep hygiene, cognitive stimulation activities, adequate pain control, and involvement of family members can lower incidence by up to 40 percent. The authors caution against routine use of medications for prevention.
Based on available evidence and expert consensus across disciplines, structured treatment approaches are recommended according to severity level and clinical context. Non-pharmacological strategies remain foundational regardless of how severe the delirium is; pharmacological treatments are considered when necessary based on symptoms and situation—with sedative dexmedetomidine shown beneficial in moderate to severe cases within intensive care settings. Use of antipsychotics requires careful evaluation due to possible cardiac side effects.
"A structured step-by-step approach is crucial," said Prof. Lüsebrink. "Our work shows that there are also evidence-based and clinically practicable treatment strategies in the cardiovascular setting - provided that delirium is detected early and treated in an interdisciplinary manner." Prof. Dr. Alexandra Philipsen from UKB's Clinic for Psychiatry stressed: "We can successfully treat our patients medically for heart conditions. But if we do not systematically recognize and prevent delirium, we risk long-term damage to the brains of those affected. Delirium prevention must therefore become an integral part of cardiovascular care."
While understanding has grown about this issue within cardiology circles globally—including calls from leading organizations such as the American Heart Association (https://www.sciencedirect.com/science/article/pii/S0735109723036357)—the review notes that specific evidence regarding cardiovascular patient groups remains limited. The authors urge more targeted research through prospective studies to establish dedicated guidelines tailored specifically for these populations.
