# Predictive Factors and Onset Timing of Delirium in Hospitalized Patients with Heart Failure

## TL;DR

This study identifies factors linked to early and late-onset delirium in heart failure patients, emphasizing the role of anticholinergic load and malnutrition.

## Contribution

The study distinguishes predictive factors for early versus late-onset delirium in heart failure patients, highlighting anticholinergic load and malnutrition as key contributors.

## Key findings

- Early-onset delirium is associated with higher anticholinergic load and C-reactive protein levels.
- Late-onset delirium correlates with malnutrition and body mass index.
- Hyperactive delirium is more common in early-onset cases, while hypoactive or mixed subtypes are prevalent in late-onset cases.

## Abstract

This study aimed to examine the predictive factors and timing of delirium onset in hospitalized patients with heart failure, focusing on the impact of total anticholinergic load and other contributing variables.

The single-site retrospective cohort study included 694 patients hospitalized for heart failure and receiving treatment for hyperpolypharmacy between January 2015 and March 2023. The patients were categorized into delirium and non-delirium groups, with the delirium group further subdivided into early-onset (within 6 days) and late-onset (day 7 or later) subgroups. Logistic regression analyses were performed to identify significant factors associated with delirium onset.

Compared with the non-delirium group, the delirium group (n = 54) showed a higher total anticholinergic load, malnutrition prevalence, and elevated N-terminal pro-brain natriuretic peptide levels. Early-onset delirium was associated with a higher total anticholinergic load and C-reactive protein levels, whereas late-onset delirium correlated with malnutrition. Hyperactive delirium was predominant in the early-onset group and the hypoactive or mixed subtypes in the late-onset.

Elevated anticholinergic loads and the presence of infection were primary contributors to early-onset delirium; malnutrition and the body mass index were critical for late-onset delirium. These findings emphasize the need for targeted preventive strategies based on delirium onset timing.