{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T02:57:29Z","timestamp":1776826649805,"version":"3.51.2"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"Geriatric, Research, Education, and Clinical Center"},{"name":"Geriatric, Research, Education, and Clinical Center"},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR000445-06"],"award-info":[{"award-number":["UL1 TR000445-06"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Younger patients (18 to 65 years old) are often excluded from delirium outcome studies. We sought to determine if delirium was associated with short-term adverse outcomes in a diverse cohort of younger and older patients with acute heart failure (AHF). We conducted a multi-center prospective cohort study that included adult emergency department patients with confirmed AHF. Delirium was ascertained using the Brief Confusion Assessment Method (bCAM). The primary outcome was a composite outcome of 30-day all-cause death, 30-day all-cause rehospitalization, and prolonged index hospital length of stay. Multivariable logistic regression was performed, adjusting for demographics, cognitive impairment without delirium, and HF risk factors. Older age (\u2265 65 years old)*delirium interaction was also incorporated into the model. Odds ratios (OR) with their 95% confidence intervals (95%CI) were reported. A total of 1044 patients with AHF were enrolled; 617 AHF patients were &lt; 65 years old and 427 AHF patients were \u2265 65 years old, and 47 (7.6%) and 40 (9.4%) patients were delirious at enrollment, respectively. Delirium was significantly associated with the composite outcome (adjusted OR = 1.64, 95%CI: 1.02 to 2.64). The older age*delirium interaction p-value was 0.47. In conclusion, delirium was common in both younger and older patients with AHF and was associated with poorer short-term outcomes in both cohorts. Younger patients with acute heart failure should be included in future delirium outcome studies.<\/jats:p>","DOI":"10.1371\/journal.pone.0270889","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T17:49:44Z","timestamp":1658857784000},"page":"e0270889","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Delirium and its association with short-term outcomes in younger and older patients with acute heart failure"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0384-210X","authenticated-orcid":true,"given":"Jin H.","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0095-9134","authenticated-orcid":true,"given":"Candace D.","family":"McNaughton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3817-1414","authenticated-orcid":true,"given":"William B.","family":"Stubblefield","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter S.","family":"Pang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip D.","family":"Levy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen F.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Meram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mette Lind","family":"Cole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy A.","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadassah H.","family":"Paz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly M.","family":"Moser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan B.","family":"Storrow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2305-9836","authenticated-orcid":true,"given":"Sean P.","family":"Collins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the Emergency Medicine Research and Outcomes Consortium Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"issue":"11","key":"pone.0270889.ref001","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1111\/jgs.14471","article-title":"Unrecognized Cognitive Impairment and Its Effect on Heart Failure Readmissions of Elderly Adults","volume":"64","author":"KS Agarwal","year":"2016","journal-title":"Journal of the American Geriatrics Society"},{"issue":"2","key":"pone.0270889.ref002","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.amjmed.2012.05.029","article-title":"Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes","volume":"126","author":"JA Dodson","year":"2013","journal-title":"The American journal of medicine"},{"issue":"1","key":"pone.0270889.ref003","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1161\/CIRCHEARTFAILURE.114.001438","article-title":"Mini-cog performance: novel marker of post discharge risk among patients hospitalized for heart failure","volume":"8","author":"A Patel","year":"2015","journal-title":"Circulation Heart failure"},{"issue":"3","key":"pone.0270889.ref004","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.cger.2018.05.001","article-title":"Delirium and Dementia","volume":"34","author":"JH Han","year":"2018","journal-title":"Clinics in geriatric medicine"},{"issue":"5","key":"pone.0270889.ref005","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1067\/mem.2003.152","article-title":"The effect of mental status screening on the care of elderly emergency department patients","volume":"41","author":"FM Hustey","year":"2003","journal-title":"Annals of emergency medicine"},{"issue":"3","key":"pone.0270889.ref006","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.annemergmed.2010.03.003","article-title":"Delirium in the emergency department: an independent predictor of death within 6 months","volume":"56","author":"JH Han","year":"2010","journal-title":"Annals of emergency medicine"},{"key":"pone.0270889.ref007","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s12916-016-0649-8","article-title":"\"Delirium Day\": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool","volume":"14","author":"G Bellelli","year":"2016","journal-title":"BMC medicine"},{"issue":"6","key":"pone.0270889.ref008","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1111\/jgs.14824","article-title":"Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition","volume":"65","author":"JH Han","year":"2017","journal-title":"Journal of the American Geriatrics Society"},{"issue":"5","key":"pone.0270889.ref009","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1111\/j.1553-2712.2011.01065.x","article-title":"Delirium in older emergency department patients is an independent predictor of hospital length of stay","volume":"18","author":"JH Han","year":"2011","journal-title":"Acad Emerg Med"},{"issue":"2","key":"pone.0270889.ref010","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1017\/S1041610218000777","article-title":"Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients","volume":"31","author":"J Cirbus","year":"2019","journal-title":"International psychogeriatrics \/ IPA"},{"issue":"4","key":"pone.0270889.ref011","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s41999-018-0072-0","article-title":"Long-term prognostic value of functional status and delirium in emergency patients with decompensated heart failure","volume":"9","author":"RM Alberto","year":"2018","journal-title":"European Geriatric Medicine"},{"key":"pone.0270889.ref012","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.ijcard.2016.07.236","article-title":"Prevalence, determinants, and prognostic significance of delirium in patients with acute heart failure","volume":"222","author":"S Honda","year":"2016","journal-title":"International journal of cardiology"},{"issue":"1","key":"pone.0270889.ref013","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1186\/s12877-020-01928-7","article-title":"Delirium is associated with high mortality in older adult patients with acute decompensated heart failure","volume":"20","author":"M Pak","year":"2020","journal-title":"BMC geriatrics"},{"issue":"9","key":"pone.0270889.ref014","doi-asserted-by":"crossref","first-page":"799 e1","DOI":"10.1016\/j.jamda.2015.06.006","article-title":"Prognostic value and risk factors of delirium in emergency patients with decompensated heart failure","volume":"16","author":"MA Rizzi","year":"2015","journal-title":"J Am Med Dir Assoc"},{"issue":"3","key":"pone.0270889.ref015","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.amjcard.2011.03.059","article-title":"Usefulness of acute delirium as a predictor of adverse outcomes in patients >65 years of age with acute decompensated heart failure","volume":"108","author":"S Uthamalingam","year":"2011","journal-title":"The American journal of cardiology"},{"issue":"6","key":"pone.0270889.ref016","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.cardfail.2008.12.013","article-title":"The rationale for an acute heart failure syndromes clinical trials network","volume":"15","author":"SP Collins","year":"2009","journal-title":"Journal of cardiac failure"},{"issue":"4","key":"pone.0270889.ref017","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1111\/j.1553-2712.2011.01040.x","article-title":"Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: brief Alzheimer\u2019s Screen, Short Blessed Test, Ottawa 3DY, and the caregiver-completed AD8","volume":"18","author":"CR Carpenter","year":"2011","journal-title":"Acad Emerg Med"},{"issue":"6","key":"pone.0270889.ref018","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.ajem.2016.02.069","article-title":"A quick and easy delirium assessment for nonphysician research personnel","volume":"34","author":"JH Han","year":"2016","journal-title":"The American journal of emergency medicine"},{"issue":"5","key":"pone.0270889.ref019","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1001\/jama.293.5.572","article-title":"Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis","volume":"293","author":"GC Fonarow","year":"2005","journal-title":"JAMA"},{"key":"pone.0270889.ref020","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1007\/978-1-4757-3462-1","volume-title":"Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis","author":"FE Harrell","year":"2001"},{"issue":"12","key":"pone.0270889.ref021","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1164\/rccm.201506-1158OC","article-title":"Incidence and Risk Factors for Intensive Care Unit-related Post-traumatic Stress Disorder in Veterans and Civilians","volume":"193","author":"MB Patel","year":"2016","journal-title":"American journal of respiratory and critical care medicine"},{"key":"pone.0270889.ref022","article-title":"Cognitive impairment in patients hospitalized for congestive heart failure: data from the RICA Registry","author":"JM Garcia Brunen","year":"2020","journal-title":"Intern Emerg Med"},{"issue":"17","key":"pone.0270889.ref023","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1001\/archinternmed.2012.3203","article-title":"Delirium and Long-term Cognitive Trajectory Among Persons With Dementia","volume":"172","author":"AL Gross","year":"2012","journal-title":"Archives of internal medicine"},{"issue":"14","key":"pone.0270889.ref024","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1056\/NEJMoa1301372","article-title":"Long-term cognitive impairment after critical illness","volume":"369","author":"PP Pandharipande","year":"2013","journal-title":"The New England journal of medicine"},{"issue":"1","key":"pone.0270889.ref025","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1056\/NEJMoa1112923","article-title":"Cognitive trajectories after postoperative delirium","volume":"367","author":"JS Saczynski","year":"2012","journal-title":"The New England journal of medicine"},{"issue":"12","key":"pone.0270889.ref026","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1093\/gerona\/61.12.1294","article-title":"Cerebral perfusion changes in older delirious patients using 99mTc HMPAO SPECT","volume":"61","author":"TG Fong","year":"2006","journal-title":"The journals of gerontology"},{"issue":"3","key":"pone.0270889.ref027","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1046\/j.1440-1819.2003.01126.x","article-title":"Regional cerebral blood flow in delirium patients","volume":"57","author":"H Yokota","year":"2003","journal-title":"Psychiatry Clin Neurosci"},{"issue":"24","key":"pone.0270889.ref028","doi-asserted-by":"crossref","first-page":"3738","DOI":"10.1161\/CIRCULATIONAHA.105.561423","article-title":"Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients","volume":"112","author":"SD Solomon","year":"2005","journal-title":"Circulation"},{"issue":"18","key":"pone.0270889.ref029","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.1016\/j.jacc.2019.02.042","article-title":"Disparities in Cardiovascular Mortality Related to Heart Failure in the United States","volume":"73","author":"P Glynn","year":"2019","journal-title":"Journal of the American College of Cardiology"},{"issue":"8","key":"pone.0270889.ref030","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1056\/NEJM199902253400804","article-title":"Racial differences in the outcome of left ventricular dysfunction","volume":"340","author":"DL Dries","year":"1999","journal-title":"N Engl J Med"},{"issue":"12","key":"pone.0270889.ref031","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1016\/j.amjcard.2019.09.020","article-title":"Comparison of Hydralazine\/Nitrate and Angiotensin Receptor Neprilysin Inhibitor Use Among Black Versus Nonblack Americans With Heart Failure and Reduced Ejection Fraction (from CHAMP-HF)","volume":"124","author":"EM Giblin","year":"2019","journal-title":"The American journal of cardiology"},{"issue":"3","key":"pone.0270889.ref032","doi-asserted-by":"crossref","first-page":"e003108","DOI":"10.1161\/CIRCEP.115.003108","article-title":"Cardiac Resynchronization Therapy: US Trends and Disparities in Utilization and Outcomes","volume":"9","author":"AR Sridhar","year":"2016","journal-title":"Circ Arrhythm Electrophysiol"},{"issue":"4","key":"pone.0270889.ref033","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.114.001561","article-title":"Racial differences in clinical treatment and self-care behaviors of adults with chronic heart failure","volume":"4","author":"VV Dickson","year":"2015","journal-title":"J Am Heart Assoc"},{"issue":"19","key":"pone.0270889.ref034","doi-asserted-by":"crossref","first-page":"2544","DOI":"10.1161\/CIRCULATIONAHA.107.188965","article-title":"Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group","volume":"117","author":"DD Schocken","year":"2008","journal-title":"Circulation"},{"issue":"21","key":"pone.0270889.ref035","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1001\/jama.297.21.2391","article-title":"Does this patient have dementia?","volume":"297","author":"T Holsinger","year":"2007","journal-title":"JAMA"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0270889","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T17:50:25Z","timestamp":1658857825000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0270889"}},"subtitle":[],"editor":[{"given":"Enrico","family":"Mossello","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,7,26]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0270889","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,26]]}}}