Hayashi Anna, Kobayashi Sayaka, Matsui Kentaro, Akaho Rie, Nishimura Katsuji
Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho 8-1, Shinjuku-ku, Tokyo, Japan.
Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Biopsychosoc Med. 2020 Jul 29;14:15. doi: 10.1186/s13030-020-00188-6. eCollection 2020.
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.
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.
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% ( = 41; Agreement group). Age, sex, and HF severity did not differ significantly between the two groups. Although disquietedness was identified most frequently ( = 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.
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.
伴有谵妄的心力衰竭（HF）患者有再次住院和死亡的风险，因此早期发现和适当治疗至关重要。HF患者的姑息治疗是一个重要问题，特别是对于同时患有谵妄的患者。这项回顾性研究检查了治疗HF患者的心脏病专家对谵妄评估的准确性，确定了与谵妄检测相关的因素，并记录了初始治疗情况。
这是一项对一家综合医院心脏病病房6年期间转诊至会诊联络（C-L）服务的165例HF患者进行的回顾性病历调查。C-L精神科医生对谵妄的诊断基于《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）。心脏病专家在病历中注明“谵妄”的病例被分类为对谵妄的准确评估（一致组）。心脏病专家未注明“谵妄”的病例被分类为不一致组。
在81例谵妄患者中（51例[62.9%]为男性；年龄74.7±13.3岁），心脏病专家对谵妄的准确评估率为50.6%（n = 41；一致组）。两组之间的年龄、性别和HF严重程度无显著差异。尽管不安是最常被识别出的症状（n = 59，73%），但这59例患者中只有33例（55.9%）被心脏病专家识别为患有谵妄。不适当的初始治疗仅在不一致组中被注意到。在两组中，大多数病例被转诊至C-L服务，且未针对精神症状使用新药物。
心脏病专家对HF住院患者谵妄的准确评估仅在约一半的病例中被发现。准确检测对于避免有害药物给药和提供适当的姑息治疗很重要。
