Patterns Of Survivors' recovery Trajectories in the ICECAP trial (POST-ICECAP)

ICECAP 试验中幸存者的康复轨迹模式 (POST-ICECAP)

基本信息

批准号：
10660518
负责人：
Sachin Agarwal
金额：
$ 259.64万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-01 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10660518
关键词：
Acute Ancillary Study Back Black race Brain Caring Characteristics Clinical Cognition Cognitive Cognitive deficits Coma Consciousness Disorders Continuity of Patient Care Coronary Angiography Critical Care Data Dependence Deterioration Discrimination Disparity Eligibility Determination Emergency Care Employment Enrollment Environmental Risk Factor Equity Ethnic Origin Event Family Funding Guidelines Health Heart Arrest Hispanic Home Hospitalization Hospitals Hour Impaired cognition Impairment Individual Inpatients Insurance Intervention Knowledge Latinx Length of Stay National Heart, Lung, and Blood Institute National Institute of Neurological Disorders and Stroke Neurologic Not Hispanic or Latino Outcome Outcome Assessment Outpatients Parents Patient Self-Report Patients Pattern Persons Physiological Pilot Projects Public Health Quality of life Race Randomized Recovery Recovery of Function Rehabilitation therapy Reporting Resuscitation Role Science Severities Severity of illness Site Skilled Nursing Facilities Socioeconomic Factors Survivors Telephone Testing United States National Institutes of Health Videoconferencing Visit Work acute care clinical practice cognitive recovery cohort comorbidity disability ethnic disparity ethnic diversity experience follow-up functional outcomes health care availability health related quality of life hospital care hypoxic ischemic injury improved indexing individual patient individual variation long term recovery natural hypothermia out-of-hospital cardiac arrest patient variability performance based measurement preservation primary outcome psychological distress racial disparity racial diversity racism recruit secondary outcome social factors social health determinants survivorship treatment as usual

项目摘要

Project Summary: Many patients now survive out-of-hospital cardiac arrest (OHCA), however gaps in knowledge about long-term outcomes result in a fragmented and underdeveloped continuum of care to achieve recovery. Recovery is defined as significant improvement in functional and cognitive outcomes, and health- related quality of life (HRQoL). OHCA Survivors with favorable recovery patterns may potentially go back to work and/or social roles. Prior studies assessing recovery domains after OHCA are small, limited to single centers, and short-term outcomes i.e., 1-3 months. Identifying individual patient patterns of recovery over longer-term, and the ability to predict who will be likely to need more intensive support after discharge would allow interventions to be targeted more efficiently. It is also crucial that we offer patients and their families the best information available about a patient's prospects for continued recovery even in the absence of modifiable intervention targets. This study will be among the first to focus on a new equitable science of OHCA survivorship itself, seeking empirically derived targets for preserving or restoring recovery. Our single-center pilot study has found that nearly one-third of the OHCA survivors had clinically important differences between long-term (12 months) and short-term (3 months) functional outcomes with large between- individual variability in recovery (i.e., improvement or worsening). We found that inpatient acute rehabilitation was associated with better functional recovery patterns at 12 months compared to other dispositions, but Black race and Hispanic/Latinx had worse recovery patterns than non-Hispanic Whites. To fill this gap, we propose an ancillary study to the NINDS/NHLBI-funded ICECAP trial, conducted within the 60 sites of the NIH emergency care trials network, to describe recovery (functional outcome [primary], Cognition, and HRQoL outcomes [secondary]) in a large, well-characterized, racially/ethnically diverse, representative cohort of US OHCA patients. We will enroll n=1,000 who were screened for ICECAP and survive to hospital discharge. The parent ICECAP trial includes a telephone follow-up visit at 1 month and an in-person visit at 3 months. The ancillary study will add two telephone/videoconferencing visits at 6 and 9 months and an in-person visit at 12 months after OHCA. For Aim 1, we will describe between-patient variability in recovery (i.e., improvement in functional, cognitive, and HRQoL outcomes) from 3 to 12 months after OHCA, and test whether changes are associated with illness severity scores, and critical care interventions performed during the acute care stay. Aim 2 will test whether receipt of acute inpatient rehabilitation (vs outpatient therapy/no therapy/skilled nursing facility) within 1 month of hospital discharge is associated with greater improvement in recovery outcomes from 3 to 12 months. Finally, in Aim 3, we will test whether non-Hispanic Black and Hispanic/Latinx patients have less favorable changes in recovery outcomes between 3 and 12 months and explore mechanisms for such disparities.

项目摘要：现在，许多患者在院外心脏骤停 (OHCA) 中幸存下来，但仍存在差距对长期结果的了解导致护理的连续性支离破碎且不发达，以实现恢复。康复被定义为功能和认知结果以及健康的显着改善相关生活质量 (HRQoL)。具有良好康复模式的 OHCA 幸存者可能会返回工作和/或社会角色。先前评估 OHCA 后恢复范围的研究规模较小，仅限于单个中心和短期结果，即 1-3 个月。识别个体患者的康复模式从长远来看，预测出院后谁可能需要更多强化支持的能力将使干预措施更有针对性。同样重要的是，我们为患者及其家人提供即使在没有可修改的情况下，有关患者持续康复前景的最佳信息干预目标。这项研究将是首批关注 OHCA 的新公平科学的研究之一生存本身，寻求根据经验得出的目标来维持或恢复恢复。我们的单中心试点研究发现，近三分之一的 OHCA 幸存者患有临床上重要的疾病长期（12 个月）和短期（3 个月）功能结果之间存在较大差异恢复的个体差异（即改善或恶化）。我们发现住院患者急性康复与其他处置相比，Black 在 12 个月时与更好的功能恢复模式相关，但 Black 种族和西班牙裔/拉丁裔的恢复模式比非西班牙裔白人更差。为了填补这一空白，我们建议对 NINDS/NHLBI 资助的 ICECAP 试验进行一项辅助研究，该试验在 NIH 紧急护理试验网络的 60 个站点，用于描述恢复情况（功能结果[主要]、认知和 HRQoL 结果[次要]）在一个大的、特征鲜明的、种族/民族多样化的、美国 OHCA 患者的代表性队列。我们将招募 n=1,000 名经过 ICECAP 筛查的人存活至出院。家长 ICECAP 试验包括 1 个月的电话随访和 3个月时亲自拜访。辅助研究将在 6 点和 9 点增加两次电话/视频会议访问个月以及 OHCA 后 12 个月时的亲自访视。对于目标 1，我们将描述患者之间康复的差异（即功能、认知、和 HRQoL 结果）从 OHCA 后 3 到 12 个月，并测试变化是否与疾病相关严重程度评分以及在急性护理期间进行的重症护理干预措施。目标 2 将测试是否 1 个月内接受急性住院康复治疗（与门诊治疗/无治疗/专业护理机构相比）出院次数与 3 至 12 个月内康复结果的更大改善相关。最后，在目标 3 中，我们将测试非西班牙裔黑人和西班牙裔/拉丁裔患者的偏好是否较差 3 至 12 个月之间恢复结果的变化，并探讨这种差异的机制。