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.

医疗保健的进步以及传播心肺复苏的有效公共卫生运动 (CPR) 和便携式除颤器，在过去十年中使心脏骤停 (CA) 的存活率翻了一番（从 16% 至 33%）心脏停止跳动多分钟的患者现在已经复苏，并被留在医疗机构中。 诱发昏迷，并将他们的身体冷却至 89°- 93°F（以减少脑损伤），从而导致更多的 CA 然而，CA 患者发生重大不良反应的风险仍然明显升高。 心血管事件（MACE）和全因死亡率（ACM），许多人报告健康相关质量较差 CA 后一年的生活（HRQoL）——尽管恢复独立（并且经常工作）并且认知完好。 我们建议，心脏焦虑（即心脏特异性恐惧、回避行为和过度的心脏症状） 监测）可以部分解释 MACE/ACM 风险和 HRQOL 不良，这在 CA 患者中非常普遍。 已被证明在非 CA 心血管疾病 (CVD) 患者中与较高的 CVD 发生率相关 相关的痛苦、避免体力活动、患者报告的残疾和感知健康状况不佳。 我们将建立一个CA幸存者的前瞻性队列，全面评估心脏焦虑和其他 CA 在生存第一年的心理和行为后果，并估计相关性 我们将登记心脏焦虑、体力活动和睡眠以及随后的 MACE/ACM 和 HRQoL。 由 246 名 CA 住院患者组成的队列，在入组时评估心理和 HRQoL 测量，并在 1、6、 我们将在出院后 2 周内通过体动记录仪评估身体活动和睡眠情况，并再次进行评估。 为期 2 周，然后进行 6 个月的随访，并跟踪参与者 12 个月以进行 MACE/ACM。 这是第一个关于 CA 生存的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 出院时心脏焦虑与随后的预期关联 调整一般心理困扰和其他显着临床协变量后的 CVD/死亡风险 并测试其与 HRQoL 的独立关联。我们的第二个目标是测试 CA 后的心脏焦虑是否存在。 与出院后不久的体力活动量低和/或睡眠时间短有关。 与 CVD 风险和慢性疾病进展有关，但没有研究评估 CA 的 PA 或睡眠 我们的试点数据表明，其他急性心脏事件的幸存者报告避免体力活动。 因为它会引起威胁性的生理信号（即心率加快、呼吸短促），并且 最后，我们的第三个目标是量化低 PA 和/或短睡眠的程度。 CA 预测 MACE/ACM，并介导心脏焦虑与 12 个月 MACE/ACM 之间的关联 CA 出院后通过确定可延展的干预目标来改善 CVD/死亡率风险和 CA 后生活质量，这项研究可能会激发第一代 CA 幸存者的发展 干预措施。