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

医疗保健方面的进展，以及传播心肺复苏的有效公共卫生运动 心肺复苏术(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%)。心脏停止跳动许多分钟的患者现在被复苏，被关在医学上 导致昏迷，并让他们的身体冷却到89°-93°F(以减少脑损伤)，导致更多的CA 幸存者恢复了正常的生活。然而，CA患者发生严重不良反应的风险仍然显著增加。 心血管事件(MACE)和全因死亡(ACM)，许多人报告与健康相关的质量较差 CA后一年的生活(HRQL)--尽管恢复了独立(经常是工作)，认知完好无损。 我们认为心脏焦虑(即心脏特有的恐惧、回避行为和过度的心脏症状 监测)可能部分解释了MACE/ACM风险和较差的HRQOL。它在CA患者中高度流行， 已有研究表明，在非CA心血管疾病(CVD)患者中，心血管疾病的发生率较高。 相关的痛苦，避免体力活动，病人报告的残疾，以及感觉到的健康状况不佳。 我们将建立CA幸存者的预期队列，全面评估心脏焦虑和其他 CA在存活第一年的心理和行为后果，并估计其相关性 心脏焦虑、体力活动和睡眠与随后的MACE/ACM和HRQL有关。我们将招收一个 246名CA住院患者的队列，在登记时评估心理和HRQL测量，并通过电话1，6， 还有12个月。我们将在出院后的两周内通过活动记录仪评估体力活动和睡眠情况，并再次进行评估。 两周后进行为期6个月的随访，并对参与者进行为期12个月的MACE/ACM随访。这将是 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，我们将评估在CA出院时心脏焦虑与随后的 在调整了一般心理痛苦和其他重要临床协变量后的心血管疾病风险/死亡率 并测试其与HRQOL的独立关联性。我们的第二个目标是测试CA后的心脏焦虑 与出院后不久体力活动不足和/或睡眠不足有关。身体活动(PA)和睡眠 与心血管疾病风险和慢性疾病进展有关，但还没有研究评估CA患者的PA或睡眠 幸存者。我们的试验数据表明，其他急性心脏事件的幸存者报告避免体力活动 因为它会引起危险的生理信号(即心率加快、呼吸急促)， 因心脏焦虑症而入睡。最后，我们的第三个目标是量化低PA和/或短睡眠的程度 CA后预测MACE/ACM，并中介心脏焦虑与12个月MACE/ACM的关系 CA出院后。通过确定可延展的干预目标来改善心血管疾病/死亡率风险和 CA术后的生活质量，这项研究可以点燃第一代CA存活者的发展 干预措施。

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.