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Association between postoperative delirium and heart rate variability in the intensive care unit and readmissions and mortality in elderly patients with cardiovascular surgery

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Abstract

This study aimed to investigate the relationship between heart rate variability (HRV), a parameter of the autonomic nervous system activity (ANSA), and postoperative delirium and postoperative events. This retrospective cohort study included elderly patients aged 65 years or older who were admitted to the intensive care unit (ICU) after cardiovascular surgery. ANSA was measured using HRV parameters for 1 h at daytime and 1 h at night-time before ICU discharge. The primary endpoint was the effect of HRV parameters and delirium on mortality and readmission rates within 1 year after discharge, and the secondary endpoint was the association between HRV parameters and delirium. Cox proportional hazards models were used to examine the association between HRV parameters and postoperative events by adjusting for delirium and pre and postoperative information. A total of 71 patients, 39 without delirium and 32 with delirium, met the inclusion criteria. The incidence of death and readmission within 1 year was significantly higher in the delirium group and in the group with higher daytime HF (high frequency power) and r-MSSD (square root of the squared mean of the difference of successive NN intervals), parameters of the parasympathetic nervous system activity (PNSA), than that in other groups. Furthermore, the delirium group had significantly higher HF and r-MSSD than the nondelirium group. Even after adjusting for confounding factors in the multivariate analysis, a trend of higher daytime HF and r-MSSD was observed, indicating a significant effect on the occurrence of combined events within 1 year of discharge. ICU delirium has been associated with higher daytime HF and r-MSSD, parameters of PNSA. ICU delirium was a prognostic factor, and increased daytime PNSA may worsen the prognosis of elderly patients after cardiovascular surgery.

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Acknowledgements

We would like to thank the cardiac rehabilitation team of Shinshu University for their cooperation in data collection and the patients who underwent cardiovascular surgery at Shinshu University for participating in this study.

Funding

This research was supported by a research grant from the Japanese Physical Therapy Association (No. 20-A19).

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Authors and Affiliations

  1. Department of Rehabilitation, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Daichi Tsukakoshi, Shuhei Yamamoto, Shuhei Takeda, Natsuko Oguchi & Hiroshi Horiuchi

  2. Division of Physical Therapy, School of Health Sciences, Shunshu University, Matsumoto, Nagano, Japan

    Ippei Nojima

  3. Division of Occupational Therapy, School of Health Sciences, Shunshu University, Matsumoto, Nagano, Japan

    Masaaki Sato

  4. Department of Nursing, Shinshu University Hospital, Nagano, Japan

    Keisuke Furuhashi & Sho Kasuga

  5. Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan

    Hajime Ichimura, Yuko Wada & Tatsuichiro Seto

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  1. Daichi Tsukakoshi
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Correspondence to Shuhei Yamamoto.

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Tsukakoshi, D., Yamamoto, S., Nojima, I. et al. Association between postoperative delirium and heart rate variability in the intensive care unit and readmissions and mortality in elderly patients with cardiovascular surgery. Heart Vessels 38, 438–447 (2023). https://doi.org/10.1007/s00380-022-02173-1

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