{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T20:31:41Z","timestamp":1759091501562,"version":"3.41.2"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The impact of demand ischemia on clinical outcomes in patients with delirium remains largely unexplored. This study aims to evaluate the effects of demand ischemia in older patients with delirium on in-hospital mortality and length of stay (LOS) using the largest US inpatient care database, National Inpatient Sample (NIS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We obtained data from the year 2010 to 2014 National Inpatient Sample (NIS). We used the International Classification of Diseases-Ninth Edition-Clinical Modification (ICD-9-CM) diagnosis codes to identify all the records with a primary or secondary diagnosis of delirium with or without demand ischemia and other clinical characteristics. We then compared in-hospital mortality and length of stay (LOS) in patients with and without demand ischemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We analyzed 232,137 records. Patients with demand ischemia had higher overall in-hospital mortality than those without demand ischemia (28 vs. 12%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001). After adjusting for clinical comorbidities and complications, demand ischemia was no longer associated with increased in-hospital mortality (OR: 1.14; 95% CI: 0.96\u20131.35; <jats:italic>p<\/jats:italic> = 0.141). However, further analysis with the exclusion of critically ill patients with non-cardiogenic shock or mechanical ventilation showed a significant association of demand ischemia with increased in-hospital mortality (adjusted OR: 1.39; 95% CI: 1.13\u20131.71; <jats:italic>p<\/jats:italic> = 0.002). Among non-critically ill survivors, patients with demand ischemia had a longer median LOS [4, (3\u20137) days] than those without demand ischemia [4, (2\u20136) days] (<jats:italic>p<\/jats:italic> &amp;lt; 0.001). However, the difference was not statistically significant after adjustment for covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion\/Relevance<\/jats:title><jats:p>Demand ischemia did not affect mortality in critically sick patients. In non-critically ill patients, however, demand ischemia was significantly associated with increased in-hospital mortality, likely due to the severity of the underlying acute illness. Measures aimed at mitigating risk factors that contribute to delirium and\/or demand ischemia need to be explored.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.917252","type":"journal-article","created":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T06:05:12Z","timestamp":1654495512000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Demand Ischemia as a Predictor of Mortality in Older Patients With Delirium"],"prefix":"10.3389","volume":"9","author":[{"given":"Manish","family":"Kumar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivaraj","family":"Patil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas Da Cunha","family":"Godoy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Ling","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Swede","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George A.","family":"Kuchel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e153","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart disease and stroke statistics-2022 update: a report from the American heart association","volume":"145","author":"Tsao","year":"2022","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.cger.2009.07.007","article-title":"The burden of cardiovascular disease in the elderly: morbidity, mortality, and costs","volume":"25","author":"Yazdanyar","year":"2009","journal-title":"Clin Geriatr Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.33963\/KP.15585","article-title":"Use of cardiac troponin in the early diagnosis of acute myocardial infarction","volume":"78","author":"Muzyk","year":"2020","journal-title":"Kardiol Pol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1093\/eurheartj\/ehq456","article-title":"Troponin elevation in coronary vs. non-coronary disease","volume":"32","author":"Agewall","year":"2011","journal-title":"Eur Heart J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1038\/s41572-020-00223-4","article-title":"Delirium","volume":"6","author":"Wilson","year":"2020","journal-title":"Nat Rev Dis Primers."},{"key":"B6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.genhosppsych.2020.08.010","article-title":"Delirium in elderly patients: prospective prevalence across hospital services","volume":"67","author":"Fuchs","year":"2020","journal-title":"Gen Hosp Psychiatry."},{"key":"B7","doi-asserted-by":"publisher","first-page":"638493","DOI":"10.1155\/2014\/638493","article-title":"Repetitive myocardial infarctions secondary to delirium tremens","volume":"2014","author":"Schwartzberg","year":"2014","journal-title":"Case Rep Crit Care."},{"key":"B8","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.jpsychores.2008.05.019","article-title":"Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses","volume":"65","author":"Maclullich","year":"2008","journal-title":"J Psychosom Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1097\/MCA.0000000000000978","article-title":"Delirium is an important predictor of mortality in elderly patients with ST-elevation myocardial infarction: insight from National Inpatient Sample database","volume":"31","author":"Patil","year":"2020","journal-title":"Coron Artery Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1002\/clc.22972","article-title":"Impact of delirium on patients hospitalized for myocardial infarction: a propensity score analysis of the National Inpatient Sample","volume":"41","author":"Abdullah","year":"2018","journal-title":"Clin Cardiol."},{"unstructured":"Overview of the National (Nationwide) Inpatient Sample (NIS)(Agency for Healthcare Research and Quality, Rockville, MD)","key":"B11"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2231","DOI":"10.1016\/j.jacc.2018.08.1038","article-title":"Fourth universal definition of myocardial infarction","volume":"72","author":"Thygesen","year":"2018","journal-title":"J Am Coll Cardiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1002\/clc.22978","article-title":"Mortality in sepsis: comparison of outcomes between patients with demand ischemia, acute myocardial infarction, and neither demand ischemia nor acute myocardial infarction","volume":"41","author":"Shah","year":"2018","journal-title":"Clin Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"R117","DOI":"10.1186\/cc12789","article-title":"Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine","volume":"17","author":"Mehta","year":"2013","journal-title":"Crit Care."},{"key":"B15","first-page":"1818","article-title":"Serum cardiac troponin-T as a prognostic marker in septic shock","volume":"91","author":"Choon-ngarm","year":"2008","journal-title":"J Med Assoc Thai"},{"key":"B16","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ijcard.2003.02.005","article-title":"Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock","volume":"95","author":"Mehta","year":"2004","journal-title":"Int J Cardiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12871-018-0515-7","article-title":"Association between troponin-I levels and outcome in critically ill patients admitted to non-cardiac intensive care unit with high prevalence of cardiovascular risk factors","volume":"18","author":"Alatassi","year":"2018","journal-title":"BMC Anesthesiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.amjmed.2013.12.020","article-title":"Mortality rate in type 2 myocardial infarction: observations from an unselected hospital cohort","volume":"127","author":"Saaby","year":"2014","journal-title":"Am J Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1111\/acem.13033","article-title":"Causes of elevated cardiac troponins in the emergency department and their associated mortality","volume":"23","author":"Meigher","year":"2016","journal-title":"Acad Emerg Med."},{"key":"B20","first-page":"150","article-title":"Delirium in older persons: evaluation and management","volume":"90","author":"Kalish","year":"2014","journal-title":"Am Fam Physician."},{"key":"B21","first-page":"15","article-title":"Comparison between type-2 and type-1 myocardial infarction: clinical features, treatment strategies and outcomes","volume":"13","author":"Lopez-Cuenca","year":"2016","journal-title":"J Geriatr Cardiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1056\/NEJMra1808137","article-title":"Acute infection and myocardial infarction","volume":"380","author":"Musher","year":"2019","journal-title":"N Engl J Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1161\/CIRCULATIONAHA.119.040631","article-title":"Assessment and treatment of patients with type 2 myocardial infarction and acute nonischemic myocardial injury","volume":"140","author":"DeFilippis","year":"2019","journal-title":"Circulation."},{"key":"B24","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1177\/2048872614538411","article-title":"Cardiac troponin changes to distinguish type 1 and type 2 myocardial infarction and 180-day mortality risk","volume":"3","author":"Sandoval","year":"2014","journal-title":"Eur Heart J Acute Cardiovasc Care."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1016\/j.amjmed.2017.05.049","article-title":"Type 1 and 2 myocardial infarction and myocardial injury: clinical transition to high-sensitivity cardiac troponin I","volume":"130","author":"Sandoval","year":"2017","journal-title":"Am J Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1016\/j.jacc.2019.02.018","article-title":"Type 2 Myocardial infarction: JACC review topic of the week","volume":"73","author":"Sandoval","year":"2019","journal-title":"J Am Coll Cardiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1161\/CIRCULATIONAHA.119.043100","article-title":"Incidence, trends, and outcomes of type 2 myocardial infarction in a community cohort","volume":"141","author":"Raphael","year":"2020","journal-title":"Circulation."},{"key":"B28","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1001\/jama.2010.1013","article-title":"Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis","volume":"304","author":"Witlox","year":"2010","journal-title":"JAMA."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1046\/j.1532-5415.2003.51509.x","article-title":"Does delirium increase hospital stay?","volume":"51","author":"McCusker","year":"2003","journal-title":"J Am Geriatr Soc."},{"key":"B30","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.ahj.2019.09.008","article-title":"Age, knowledge, preferences, and risk tolerance for invasive cardiac care","volume":"219","author":"Nanna","year":"2020","journal-title":"Am Heart J."},{"key":"B31","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1002\/pds.4226","article-title":"Evaluation of algorithms to identify delirium in administrative claims and drug utilization database","volume":"26","author":"Kim","year":"2017","journal-title":"Pharmacoepidemiol Drug Saf."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.917252\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T06:05:17Z","timestamp":1654495517000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.917252\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,6]]},"references-count":31,"alternative-id":["10.3389\/fcvm.2022.917252"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.917252","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2022,6,6]]},"article-number":"917252"}}