RESUMO
Background: Atypical presentations of acute coronary syndrome (ACS) delay its recognition and treatment in the elderly patients. Functional decline and delirium which are common to the elderly during hospitalization, leads to cognitive impairment and poor health outcomes. Steps taken for its prevention is usually not considered the top priority by the cardiologist. The present study was conducted to identify cognitive decline among elderly patients who developed ACS during hospitalization for noncardiac illness and their outcome. Materials and Methods: Three hundred and ten elderly patients above 60 years of age with ACS were included from June 26, 2020 to October 13, 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS following admission for noncardiac illness (Group II, n = 216). Co-morbidities, medications, investigations, management, clinical outcome, and Montreal Cognitive Assessment scale were compared between the two groups at the time of admission, after 30 days and after 6 months. Results: Majority of the subjects were admitted due to acute kidney injury (27.1%) in Group II and had a non-ST elevation ACS (90.2%). Optimum management was given to a lesser extent due to the clinical condition of these patients. Poor clinical outcome, cognitive impairment during hospitalization and cognitive decline during follow-up was more in Group II. Conclusion: Clinicians must be vigilant for the development of cognitive impairment and cognitive decline when an elderly patient is admitted to the hospital, as early detection and optimum management provides better clinical and cognitive outcome.
RESUMO
BACKGROUND: Delirium, defined as an acute disorder of attention and global cognitive function is a common, serious and potentially preventable source of morbidity and mortality in hospitalized elderly patients. Different studies have shown that existence of premorbid depressive illness and use of psychotropic drugs can contribute to delirium. OBJECTIVE: To assess the incidence of post operative delirium in elderly patients with pre morbid depressive illness and on psychotropic medications undergoing coronary artery bypass grafting (a major cardiac surgery). MATERIALS AND METHODS: Prospective cohort study, Study Period: 1 ½ years. Using a prepared questionnaire after obtaining fully informed written consent. 3 visits for each patient: 1) before surgery, 2) in the ICU: 48 hours after surgery, 3) In ward after shifting out from ICU. Details from patients, care givers and nursing staff regarding features of delirium are obtained. RESULTS: Out of total 250 patients included in the study, 43 (17.2%) patients developed post operative delirium. Only 6 (20.7%) patients out of 29 who had pre morbid depression, developed post operative delirium compared to 37 (16.7%) patients out of 224 with no pre operative depression (p value: 0.6). Out of 28 patients who were on psychotropic drugs 5 (17.9%) patients developed post operative delirium compared to 38 (17.1%) patients out of 222 who did not use psychotropic drugs (P value: 1). Patients with pre morbid mental illness or those on psychotropic drugs have no increased risk to develop post operative delirium compared to general patients.