Melatonin is no more effective than placebo to prevent delirium after major cardiac surgery

Reference

Ford AH, Flicker L, Kelly R, et al. The healthy heart-mind trial: randomized controlled trial of melatonin for prevention of delirium. J Am Geriatr Soc 2020;68(1):112-119.

Synopsis

These researchers recruited adults older than 50 years who were scheduled to undergo elective coronary artery bypass graft surgery, valve replacement, or both. The researchers excluded patients who were already taking melatonin, those with underlying dementia, and those with alcohol use disorders as determined by a standard test. They randomized the patients to receive melatonin 3 mg daily (n = 98) or placebo (n = 104) starting 2 days before surgery and continuing for 7 consecutive days. The diagnosis of delirium was made by using the Confusion Assessment Method administered by a trained research nurse and confirmed by an experienced geriatric psychiatrist. Slightly more than 20% of the patients in each treatment group developed delirium, and this did not change after taking into account age, sex, heart failure, diabetes, baseline cognition, hospital location, or type of surgery. Among those who developed delirium, there was no difference in its duration or severity. The study was large enough to detect a modest reduction in the rate of delirium.