Benzodiazepines may aggravate delirium risk in acute decompensated heart failure

In patients with acute decompensated heart failure (ADHF), the use of anxiolytic benzodiazepines may worsen the risk of severe delirium, a recent study has found.

Retrospectively reviewing information from 650 treated ADHF patients, the researchers looked for potential risk factors for delirium, including sociodemographic variables, intensive care needs, the use of mechanical ventilation, surgery, and comorbidities like depression, diabetes, and dementia. Medications for ADHF were also assessed. Delirium was diagnosed in accordance with the Confusion Assessment Method.

During the study observation period, 59 patients experienced severe delirium, resulting in an incidence rate of 9.1 percent. The most common medications prescribed were diuretics (96.6 percent) and beta-blockers (68.8 percent); only 43 patients (6.6 percent) were given anxiolytic benzodiazepines.

Despite its low prescription numbers, the use of anxiolytic benzodiazepines was determined in multivariate logistic regression analysis as a significant risk factor for delirium (odds ratio [OR], 6.4, 95 percent confidence interval [CI], 2.8–15; p<0.001).

Other risk factors included mechanical ventilation or noninvasive positive pressure ventilation (OR, 6.0, 95 percent CI, 2.9–12; p<0.001), depression (OR, 3.2, 95 percent CI, 1.5–6.5; p=0.0021), the male sex (OR, 2.0, 95 percent CI, 1–3.7; p=0.042), and age (OR, 1.1, 95 percent CI, 1–1.1; p<0.001).

Looking at discriminative models, the researchers further found that including the use of anxiolytic benzodiazepines as a factor could statistically improve the predictive ability of such models for delirium (p=0.037).

“Further investigations are warranted to determine whether avoiding the use of anxiolytic benzodiazepines reduces the incidence of delirium in patients with HF,” the researchers said.