Incidence of delirium in hospitalized heart failure patients: a systematic review and meta-analysis

Objective The reported incidence of delirium in hospitalized heart failure (HF) patients in current studies was inconsistent. The objective of this study was to conduct a meta-analysis to quantify the incidence of delirium in hospitalized HF patients. Methods PubMed, The Cochrane Library, Web of Science, Embase, Ovid Medline, CINAHL, CNKI, WanFang Database, VIP, and SinoMed were systematically searched from inception to 18 May 2026. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias. Stata 18.0 was used for statistical analysis. The meta-analysis employed a random-effects model with the DerSimonian–Laird method to pool the incidence of delirium in hospitalized HF patients. Subgroup analysis, sensitivity analysis, and meta-regression analysis were undertaken to identify the sources of heterogeneity. Results Ultimately, 17 studies met the inclusion criteria, including a total of 17,944 HF patients. The meta-analysis results showed that the pooled incidence of delirium in hospitalized HF patients was 18.5% (95% confidence interval: 13.1%–24.6%; I 2 = 98.651, P < 0.001). Subgroup analysis revealed that the incidence of delirium in hospitalized HF patients may be influenced by publication year, country of data source, patients’ sex, mean age, delirium screening tools, use of sedative-hypnotics and mechanical ventilation, New York Heart Association class, hypertension, dementia, previous cerebrovascular disease, and research setting. No possible sources of heterogeneity were found in subgroup analysis or meta-regression. Funnel plots, Egger's test, and Begg's test showed no publication bias. Conclusion Incident delirium in patients hospitalized for HF is common, affecting nearly one in five patients. Subgroup analysis identified potential factors influencing delirium onset in hospitalized HF patients. Despite the substantial heterogeneity across estimates, these findings underscore the need for systematic screening and routine assessment of delirium during hospitalization. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251060226 , identifier CRD420251060226.