Characterize psychological and behavioral dimensions of cardiac arrest survivorship, and their association with 1-year mortality, cardiovascular disease risk, and health-related quality of life

描述心脏骤停幸存者的心理和行为维度及其与 1 年死亡率、心血管疾病风险和健康相关生活质量的关系

• 批准号: 10211850
• 负责人: Sachin Agarwal
• 金额: $ 80.99万
• 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: 2021-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10211850
• 关键词: Accelerometer; Acute; Adoption; American Heart Association; Anxiety; Behavior; Behavioral; Brain Injuries; Cardiac; Cardiopulmonary Resuscitation; Cardiovascular Diseases; Cardiovascular system; Chronic Disease; Clinical; Clinical Management; Cognition; Cognitive; Cohort Studies; Coma; Coronary heart disease; Data; Defibrillators; Depression screen; Development; Disease Progression; Disease-Free Survival; Distress; Enrollment; Event; Fright; Generations; Guidelines; Health; Health Campaign; Health behavior; Healthcare; Heart; Heart Arrest; Heart Rate; Home; Hospitalization; Hospitals; Hour; Induced Heart Arrest; Inpatients; Intervention; Knowledge; Learning; Literature; Measures; Mediating; Medical; Mental Depression; Mental Health; Modification; Monitor; Nervous System Physiology; Neurologic; Participant; Patients; Physical activity; Physiological; Plant Roots; Post-Traumatic Stress Disorders; Prevalence; Prognosis; Prospective Studies; Prospective cohort; Prospective cohort study; Protocols documentation; Psychosocial Assessment and Care; Public Health; Quality of life; Recommendation; Registries; Rehabilitation therapy; Reporting; Research; Resuscitation; Risk; Risk Factors; Risk Reduction; Role; SF-12; Sample Size; Secondary Prevention; Secondary to; Secure; Seminal; Sex Differences; Shortness of Breath; Signal Transduction; Sleep; Sleep disturbances; Stroke; Survival Rate; Survivors; Symptoms; Telephone; Testing; Update; Work; Wrist; actigraphy; acute coronary syndrome; adjudicate; anxiety symptoms; avoidance behavior; base; cardiovascular disorder risk; cardiovascular risk factor; clinical practice; clinically relevant; cohort; disability; follow-up; generalized anxiety; hazard; health related quality of life; heart dimension/size; improved; mortality; mortality risk; physical inactivity; poor sleep; portability; primary outcome; prospective; psychologic; psychological distress; psychosocial; recruit; secondary analysis; secondary outcome; survivorship

Advances in healthcare, and effective public health campaigns to disseminate cardiopulmonary resuscitation (CPR) and portable defibrillators, have doubled the survival rate for cardiac arrest (CA) in the last decade (from 16% to 33%). Patients whose hearts stop beating for many minutes are now resuscitated, kept in a medically induced coma, and have their bodies cooled to 89°- 93°F (to reduce brain damage), resulting in many more CA survivors returning to full lives. However, CA patients remain at markedly elevated risk for major adverse cardiovascular events (MACE) and all-cause mortality (ACM), and many report poor health-related quality of life (HRQoL) in the year after CA--despite returning to independence (and often to work) with cognition intact. We propose that cardiac anxiety (i.e., cardiac specific-fear, avoidance behavior, and excessive cardiac symptom monitoring) may partly explain MACE/ACM risk and poor HRQOL. It is highly prevalent in CA patients and has been shown in non-CA cardiovascular disease (CVD) patients to be associated with higher rates of CVD- related distress, avoidance of physical activity, patient-reported disability, and poor perceived health. We will build a prospective cohort of CA survivors, comprehensively assess cardiac anxiety and other psychological and behavioral consequences of CA in the first year of survivorship, and estimate the association of cardiac anxiety, physical activity, and sleep with subsequent MACE/ACM and HRQoL. We will enroll a cohort of 246 CA inpatients, assess psychological and HRQoL measures at enrollment, and by telephone at 1, 6, and 12 months. We will assess physical activity and sleep by actigraphy for 2-weeks after discharge and again for 2 weeks before a 6-month follow-up and follow participants for 12 months to MACE/ACM. This would be the first major prospective cohort study of CA survivorship, and the first to objectively assess health behaviors. For our Aim 1, we will estimate the prospective association of cardiac anxiety at CA discharge with subsequent risk for CVD/mortality after adjusting for general psychological distress and other significant clinical covariates and test its independent association with HRQoL. Our second aim is to test whether cardiac anxiety after CA is associated with low physical activity and/or short sleep shortly after discharge. Physical activity (PA) and sleep are implicated in CVD risk and chronic disease progression, but no study has assessed PA or sleep in CA survivors. Our pilot data suggest that survivors of other acute cardiac events report avoiding physical activity because it causes threatening physiological signals (i.e., increased heart rate, shortness of breath), and poor sleep due to cardiac anxiety. Lastly, our third aim is to quantify the extent to which low PA and/or short sleep after CA predict MACE/ACM, and mediate the association between cardiac anxiety and 12-month MACE/ACM post-discharge for CA. By identifying malleable intervention targets for improving both CVD/mortality risk and post-CA quality of life, this study could ignite the development of the first generation of CA survivorship interventions.

医疗保健的进步和有效的公共卫生运动，以传播心肺复苏 （CPR）和便携式除颤器在过去十年中的心脏骤停（CA）的生存率翻了一番（来自 16％至33％）。现在，心脏停止跳动数分钟的患者已经复苏，请保持医学上的 诱发昏迷，并将其身体冷却至89°-93°F（减少脑损伤），导致更多CA 幸存者恢复了充实的生活。但是，CA患者仍处于重大对手的风险明显升高 心血管事件（MACE）和全因死亡率（ACM），许多人报告与健康相关的质量差 Ca- dite之后的一年，生活（HRQOL）以完整的认知重返独立性（并经常工作）。 我们建议心脏动画（即心脏特异性恐惧，回避行为和过度心脏症状 监测）可能会部分解释MACE/ACM风险和HRQOL差。在CA患者中非常普遍，并且 在非CA心血管疾病（CVD）患者中已显示出与CVD-率较高有关的 相关的困扰，避免体育锻炼，患者报告的残疾和不良的健康。 我们将建立一个预期的CA幸存者，全面评估心脏动画和其他 CA在生存的第一年的心理和行为后果，并估算关联 心脏动画，体育活动以及随后的狼牙棒/ACM和HRQOL的睡眠。我们将注册 246个CA住院患者的队列，评估心理和HRQOL措施在注册时以及通过电话1、6， 和12个月。我们将在出院后进行2周的行为评估体育锻炼和睡眠 在6个月的随访之前2周，然后跟随参与者12个月进行MACE/ACM。这是 CA生存期的首次主要前瞻性队列研究，也是第一个客观评估健康行为的研究。 对于我们的目标1，我们将估计CA出院中心脏动画的预期关联 调整一般心理困扰和其他重要临床协变量后，CVD/死亡率的风险 并测试其与HRQOL的独立关联。我们的第二个目的是测试CA之后的心脏动画是否 出院后不久，与身体活动较低和/或短睡眠有关。体育锻炼（PA）和睡眠 在CVD风险和慢性疾病进展中暗示，但没有研究评估PA或睡眠 幸存者。我们的飞行员数据表明​​，其他急性心脏事件的幸存者避免了体育锻炼 因为它会引起威胁性的身体信号（即心率增加，呼吸急促）和差 由于心脏动画而入睡。最后，我们的第三个目标是量化低PA和/或短睡眠的程度 在CA预测MACE/ACM之后，并介导心脏动画与12个月MACE/ACM之间的关联 CA的后收费。通过确定可延展的干预目标，以提高CVD/死亡率风险和 CA后生活质量，这项研究可能会点燃第一代CA幸存者的发展 干预措施。