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Delirium in patients with hip fracture is associated with increased heart rate variability

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Abstract

Background

Heart rate variability (HRV) is a method to assess the autonomic nervous system and reflects possibly central brain states. HRV has previously not been examined in patients with hip fracture and delirium.

Aims

To explore HRV parameters in hip fracture patients with and without delirium.

Methods

Patients admitted to Oslo University Hospital with hip fracture and sinus rhythm in electrocardiogram (ECG) were included. Delirium was diagnosed using the confusion assessment method. HRV was assessed preoperatively after a relaxing period of five minutes, by measuring an ECG signal over 5 min. Parameters in time domain (the standard deviation of the QRS distances—SDNN) and frequency domain (total power (TP), low frequency (LF), high frequency (HF) and LF/HF ratio) were calculated.

Results

Seventy-five patients were included in the study, and 21 of them had subsyndromal delirium and were excluded from the analysis. Fifty-four patients with a mean age of 83.5 years (SD 8.6, 78% females) were included. Twenty-six patients (48%) had preoperative delirium, 11 (20%) developed delirium postoperatively, whereas 17 (31%) never developed delirium. SDNN, TP and HF values were significantly higher in patients with delirium compared to patients without delirium, and LF and LF/HF were lower. Patients developing postoperative delirium had decreased LF and increased HF before symptom onset.

Discussion

Increased SDNN, TP and HF and decreased LF values might reflect an abnormal stress response in delirium.

Conclusion

HRV measurements in patients with hip fractures provide additional information beyond heart rate and might be used to identify relevant pathophysiological factors in delirium.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Funding

The study was funded by the Research Council of Norway and the Norwegian Association for Public Health. The sponsors had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

Author information

Authors and Affiliations

  1. Vestre Viken Hospital Trust, Kongsberg Hospital, Kongsberg, Norway

    Gernot Ernst

  2. Psychological Institute, University of Oslo, Oslo, Norway

    Gernot Ernst

  3. Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway

    Leiv Otto Watne & Bjørn Erik Neerland

  4. Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway

    Morten Rostrup

  5. Department of Behavioral Sciences in Medicine, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway

    Morten Rostrup

Authors
  1. Gernot Ernst
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  2. Leiv Otto Watne
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  3. Morten Rostrup
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  4. Bjørn Erik Neerland
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Gernot Ernst and Leiv Otto Watne. The first draft of the manuscript was written by Gernot Ernst, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Gernot Ernst.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and accepted by the Regional Committee for Medical and Health Research Ethic in South-East Norway (REK 2009/450).

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Informed consent was obtained from the patients or substitute decision-makers if the patients did not have the capacity to consent.

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Ernst, G., Watne, L.O., Rostrup, M. et al. Delirium in patients with hip fracture is associated with increased heart rate variability. Aging Clin Exp Res 32, 2311–2318 (2020). https://doi.org/10.1007/s40520-019-01447-5

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