Positive and Negative Psychological Predictors of Long-Term Recovery after Cardiac Arrest

心脏骤停后长期恢复的积极和消极心理预测因素

• 批准号: 10324578
• 负责人: Jeffrey Lee Birk
• 金额: $ 77.63万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-05 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10324578
• 关键词: Activities of Daily Living; Acute; Address; Affect; American Heart Association; Autonomic nervous system; Awareness; Behavior; Behavioral Mechanisms; Behavioral Medicine; Belief; Cardiac; Cardiac Death; Cardiac health; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Characteristics; Chest; Clinical Practice Guideline; Cohort Studies; Dangerousness; Development; Disease; Distress; Ecological momentary assessment; Enrollment; Event; Frequencies; Future; Happiness; Health; Health Campaign; Healthcare; Heart; Heart Arrest; Hospitalization; Hospitals; Hour; Human; Impairment; Implantable Defibrillators; Inpatients; Intensive Care Units; Intervention; Lead; Life; Link; Literature; Long-Term Survivors; Measures; Medical; Mental Depression; Methods; Monitor; Myocardial Infarction; Neurologic; Outcome; Participant; Patients; Persons; Physical activity; Post-Traumatic Stress Disorders; Predictive Factor; Presbyterian Church; Psyche structure; Psychological Factors; Psychological Tests; Public Health; Quality of life; Recording of previous events; Recovery; Reporting; Research; Resources; Risk; Risk Factors; Role; Sampling; Shapes; Stroke; Surveys; Survival Rate; Survivors; Symptoms; System; Telephone; Testing; Ventricular Arrhythmia; Work; Wrist; actigraphy; acute care; base; cardioprotection; cardiovascular disorder risk; cohort; depressive symptoms; disability; ethnic diversity; experience; follow up assessment; health related quality of life; heart rate variability; heart rhythm; improved; indexing; infancy; interest; mortality; mortality risk; negative affect; optimism; patient population; patient screening; prevent; primary outcome; prospective; psychologic; psychological distress; psychosocial; racial diversity; recruit; sudden cardiac death; survivorship

With advances in healthcare and effective public health campaigns, the survival rate after cardiac arrest (CA) has more than doubled during the last decade. However, as highlighted by a scientific statement from the American Heart Association in 2020, CA patients remain at markedly elevated risk for poor long-term recovery after leaving the hospital. We have shown that the experience of CA can be a psychologically distressing event that induces depressive and posttraumatic stress disorder (PTSD) symptoms in >30% of patients. Further, these symptoms were associated with a tripling of risk for secondary cardiovascular disease (CVD) and mortality risk in our prior work. Despite a growing interest in conducting psychological interventions, there is no reliable method for preventing negative psychological factors (NPF) after acute cardiac events. Critically, modifiable positive psychological factors (PPF) are associated with improved quality of life (QoL), greater independence in activities of daily living (ADL), healthier behaviors, improved (higher) cardiac vagal control, fewer adverse cardiovascular events, and lower risk of dying in CVD patients. The most promising PPF in this regard are a sense of optimism, experiences of positive affect, and a belief that one’s life has purpose even in the face of the depression and distress that often follow serious cardiac events. It is unknown whether CA survivors may benefit from PPF in the same way as other CVD patients seem to do. Although the rates of elevated NPF are even higher in patients after CA than in patients after heart attack and stroke, many CA survivors actually report a positive attitude and a belief that they have a fortuitous opportunity for “a second chance at life.” The first aim of the study is to test whether PPF and NPF are associated with the measures of recovery that are most important to patients’ everyday lives—QoL and ADL—in the year after the CA in a racially and ethnically diverse sample of CA survivors. The second aim is to test whether PPF and NPF are associated with a potential behavioral mechanism underlying recovery: changes in physical activity in the first 6 months after the CA. The third aim is to determine the demographic and medical factors that predict who develops PPF and NPF after CA. We will enroll a cohort of 228 CA patients from the intensive care units (ICU) of NewYork-Presbyterian Hospital. We will assess patients’ PPF and NPF at hospital discharge (median 21 days post-CA). We will conduct follow-up assessments by phone at 3, 6, and 12 months after the CA. In the week immediately following hospital discharge and again 6 months later, we will monitor physical activity via wrist- worn actigraphy, daily positive and negative affect using mobile ecological momentary assessment, and cardiac vagal control via a chest patch. CA accounts for more than half of all cardiac deaths, and is the third leading cause of death and disability in the US. Malleable PPF and NPF may be targets for improving QoL and returning CA survivors to independent lives. This study will be the first to test the potentially cardioprotective PPF and the potentially harmful NPF to investigate how long-term recovery after CA may be improved.

随着医疗保健和有效公共卫生运动的进步，心脏骤停后的生存率（CA） 在过去的十年中，已经翻了一番以上。但是，正如来自 美国心脏协会在2020年，CA患者的长期恢复不良风险显着升高 离开医院后。我们已经表明，CA的经历可能是一个令人痛苦的事件 这影响了> 30％的患者的抑郁和创伤后应激障碍（PTSD）症状。更远， 这些符号与继发性心血管疾病（CVD）和 死亡率在我们先前的工作中风险。尽管对进行心理干预的兴趣越来越 急性心脏事件后，没有可靠的预防心理因素（NPF）的可靠方法。批判性， 可修改的阳性心理因素（PPF）与改善的生活质量（QOL）相关，更大 日常生活的独立性（ADL），更健康的行为，改善（更高）心脏迷走神经控制， CVD患者的不良心血管事件较少，死亡风险较低。最有希望的PPF 被认为是一种乐观感，积极影响的经历，并且相信自己的生活也有目的 经常发生严重心脏事件的沮丧和困扰的面孔。尚不清楚CA是否 幸存者可能会以与其他CVD患者同样的方式从PPF中受益。虽然比率 CA后患者的NPF升高甚至比心脏病发作和中风后患者更高，许多CA 幸存者实际上报告了积极的态度，并相信他们有一个幸运的机会“一秒钟 这项研究的第一个目的是测试PPF和NPF是否与 在CA之后的一年 种族和种族多样的CA存活样本。第二个目的是测试PPF和NPF是否为 与恢复的潜在行为机制相关联：第一次体育锻炼的变化 大约6个月后第三个目的是确定预测谁的人口和医学因素 大约开发PPF和NPF。我们将招募来自重症监护病房（ICU）的228名CA患者的队列 Newyork-Presterian Hospital。我们将在出院时评估患者的PPF和NPF（21天中位数） 后CA）。我们将在大约3、6和12个月的电话中通过电话进行随访评估。在一周中 住院后立即出院，六个月后，我们将通过手腕监测体育活动 - 使用移动生态瞬时评估以及心脏的磨损行为摄影，每日积极和负面影响 通过胸部贴片控制迷走神经。 CA占所有心脏死亡的一半以上，是第三名 美国的死亡和残疾原因。可延展的PPF和NPF可能是改善QOL的目标 将CA存活返回独立生活。这项研究将是第一个测试潜在的心脏保护 PPF和潜在的有害NPF研究CA后长期恢复的如何改善。