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Dapagliflozin Effects on Biomarkers, Symptoms, and Functional Status in Patients With Heart Failure With Reduced Ejection Fraction: The DEFINE-HF Trial Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study How Low to Go With Glucose, Cholesterol, and Blood Pressure in Primary Prevention of CVD Correlation between frequency-domain optical coherence tomography and fractional flow reserve in angiographically-intermediate coronary lesions Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study Classic crush and DK crush stenting techniques Frequency of nonsystem delays in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention and implications for door-to-balloon time reporting (from the American Heart Association Mission: Lifeline program) Long-term Survival following Multivessel Revascularization in Patients with Diabetes (FREEDOM Follow-On Study) Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials

Review Article2020 Nov, 13 (21) 2453–2466

JOURNAL:J Am Coll Cardiol. Article Link

Delirium After TAVR: Crosspassing the Limit of Resilience

Kvan der Wulp , MH van Wely , MJP Rooijakkers et al. Keywords: delirium; post TAVR

ABSTRACT

Patients who undergo transcatheter aortic valve replacement often are frail and elderly. Delirium is a frequently observed complication, associated with impaired recovery, prolonged hospital stay, and mortality. In different hospital settings, interventions that reduced the incidence of delirium resulted in improved clinical outcome and reduced costs. In that context, prevention, early recognition, and timely interventions could be the next step toward better outcomes of transcatheter aortic valve replacement. This review is focused on awareness and recognition of delirium, including predisposing “vulnerability” factors (such as cognitive impairment and carotid artery disease) and “trigger” factors (such as anesthesia, hemodynamic imbalance, and complications). For prevention and treatment, clinicians should focus on sleep hygiene, orientation, pain management, and early mobilization. In case of delirium, a thorough search and treatment of trigger factors is warranted. Future studies should focus on risk assessment, preventive and therapeutic interventions, and their potential benefit in terms of costs and clinical outcomes.