Written by Marlene Hollick, Ed.D., R.D. Based on a randomized, double-blind, placebo-controlled study exploring the effects of melatonin on delirium in elderly acute heart failure patients while in the ICU, results demonstrated that melatonin could reduce the incidence of delirium, average lengths of stay, and costs of hospitalization.
Classified as a temporary organic mental disorder, delirium is a common but potentially life-threatening clinical syndrome that can result in increased rates of disability and mortality 1. The incidence of post-operative delirium in geriatric populations has been reported to reach rates as high as 46% 2. The incidence of geriatric patients diagnosed with cardiovascular diseases has likewise increased 3. A higher 90-day mortality rate was associated with older patients who presented acute decompensated heart failure with delirium 4, but the diagnosis and treatment of delirium remain challenging due to a deficit of specific, evidence-based drug treatments.
Melatonin, secreted by the pineal gland, is an antioxidant and free-radical scavenger that does not demonstrate toxicity when passed through the blood-brain barrier in large doses 5 and could potentially be effective in the treatment of delirium 6. The mechanisms of melatonin’s actions are associated with anti-vasospasm effects, improvements in cerebral perfusion, and antineuronal apoptosis 7.
To note the effects of melatonin on delirium in elderly patients with heart failure, a study was designed in Jiangsu, China that ran from October 1, 2015 – October 1, 2019. The trials were randomized, double-blind, and placebo controlled. 497 eligible patients over the age of 60, in the ICU with acute heart failure, were selected for the study. Within seven days after the onset of acute heart failure, patients were randomly assigned to receive 3 gm/day of melatonin (experimental group, N=249) or a placebo (control group, N=248). SPSS 14.0 was utilized for statistical analyses, and a value of P < 0.05 was selected to determine statistical significance.
Results of the study demonstrated:
- A 32% total incidence of delirium among acute heart failure patients while in the ICU.
- A 36.9% incidence of delirium in the placebo (control group), compared to 27% in the melatonin (experimental group). These results were statically significant (P = 0.021).
- A 38.1% all-cause mortality rate among the melatonin group, compared to 44.7% among the placebo group. These results were not statistically significant (P = 0.146).
- An 18.1-day average length of stay for the melatonin group, compared to 18.9 days for the placebo group. These results were statistically significant (P = 01).
- An average hospitalization cost of $5850 for the melatonin group, compared to $6470 for the placebo group. These results were statistically significant (P = 0.01).
Results showed that among elderly acute heart failure patients in the ICU, hospital costs and lengths of stay can be lowered with a reduction in delirium. However, the administration of melatonin did not improve 30-day all-cause mortality rates after acute heart failure. Limitations of the study included lack of follow-up on quality of life or activities of daily living, and lack of baseline delirium or cognitive function assessments. Additionally, clinical factors including pain, daily delirium prevalence rates, and endotracheal intubation times were not included in the study. Further research on the effects of varying doses of melatonin for delirium in acute heart failure elderly patients is indicated.
Source: Yin, B., Ye, T., Liu, Y., Wan, R., Gu, L., and Zong, G. (2022). Effects of melatonin for delirium in elderly acute heart failure patients: A randomized, single-center, double-blind, and placebo-controlled trial. The Heart Surgery Forum, 25(1), E37-E41. DOI:10.1532/hsf.4325
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Posted August 4, 2022.
Marlene Hollick, Ed.D., M.P.H., M.A., R.D, has decades of hands-on experience and academic expertise across a wide range of health and nutrition disciplines, including home care, hospitals, nursing homes, public schools, and higher education. Dr. Hollick earned her Ed.D. in Higher Education Leadership and Health Care Education from Nova Southeastern University, a Master of Public Health from New York University, and a Master of Arts in Food and Nutrition, also from NYU. She is a Registered Dietitian, a Certified Dietitian/Nutritionist, and is currently enrolled in the post-graduate Science Writing program at Johns Hopkins University.
References:
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- Saczynski JS, Marcantonio ER, Quach L, et al. Cognitive trajectories after postoperative delirium. The New England journal of medicine. Jul 5 2012;367(1):30-9. doi:10.1056/NEJMoa1112923
- Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. May 2019;18(5):439-458. doi:10.1016/s1474-4422(19)30034-1
- Pak M, Hara M, Miura S, et al. Delirium is associated with high mortality in older adult patients with acute decompensated heart failure. BMC Geriatr. Dec 3 2020;20(1):524. doi:10.1186/s12877-020-01928-7
- Chen J, Chen G, Li J, et al. Melatonin attenuates inflammatory response-induced brain edema in early brain injury following a subarachnoid hemorrhage: a possible role for the regulation of pro-inflammatory cytokines. J Pineal Res. Oct 2014;57(3):340-7. doi:10.1111/jpi.12173
- Han Y, Wu J, Qin Z, et al. Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta-analysis. J Pineal Res. May 2020;68(4):e12644. doi:10.1111/jpi.12644
- Chen J, Wang Y, Hu X, et al. The Role of Statins in the Management of Delirium: Recent Advances. CNS Neurol Disord Drug Targets. Oct 26 2021;20(3):203-215. doi:10.2174/1871527319666200720111318
