INCIDENCE AND PREDICTORS OF DELIRIUM IN PATIENTS OVER-65 WITH STEMI ADMITTED TO THE CARDIAC INTENSIVE CARE UNIT (CICU): A PROSPECTIVE OBSERVATIONAL STUDY

S. Gavagni¹, R. Giacalone¹, G. Paoli¹, R. Delsanto¹, R.B. Dicembrino¹, F. Lauretani², R. La Sala³, M.G. Maggio⁴, G. Niccoli⁵, A. Sollami⁶ | ¹Azienda Ospedaliero Universitaria, Parma, Italy; ²AUSL Romagna Ospedale Santa Maria delle Croci, Ravenna, Italy; ³Università degli Studi, Parma, Italy; ⁴Azienda Ospedaliero Universitaria, Università degli Studi, Parma, Italy; ⁵Azienda Ospedaliero Universitaria, Università degli Studi, Parma; ⁶Azienda Ospedaliero Universitaria Parma, Italy

Introduction. Delirium is a frequent and often underdiagnosed neuropsychiatric complication in hospitalized elderly patients, with particularly high incidence rates in intensive care settings. In patients with acute cardiac conditions, delirium is associated with significant adverse outcomes, including functional decline, prolonged hospital stay, and increased mortality. Although existing literature highlights the multifactorial role of in-hospital precipitants, there is a lack of specific risk stratification models for the elderly population affected by STEMI, who often present to the Cardiac Intensive Care Unit (CICU) with acute pain symptoms.
Methods. This is a prospective observational study conducted at the University Hospital of Parma. The sample includes patients aged ≥65 years admitted with a diagnosis of STEMI. The protocol involves a three-phase multidisciplinary assessment: 1) baseline screening, including the measurement of admission chest pain using the Visual Analogue Scale (VAS), comorbidity indices (CIRS), functional status (Katz/Lawton), and nutritional status (MUST); 2) diagnosis of delirium via the 4AT test (score ≥4) and neurological evaluation in the CICU; 3) follow-up at 1 month post-discharge with cognitive (MMSE) and motor (SPPB) assessment. Data analysis utilizes descriptive statistical tests and multivariate logistic regression models to determine whether pain intensity (VAS) and other clinical parameters represent independent risk factors for the development of delirium.
Results. We expect to accurately quantify the incidence of delirium in the specific subgroup of over-65 STEMI patients. By correlating the experience of pain upon admission with the onset of the complication, this study aims to provide robust data for a multidisciplinary clinical management program focused on prevention.
Conclusions. This study aims to define the risk profile of the elderly patient with STEMI, laying the groundwork for the application of clinical best practices capable of improving acute pain management and reducing the incidence of delirium in the CICU.