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

医疗保健的进步和有效的公共卫生运动，以传播心肺复苏术 (CPR)和便携式呼吸机，在过去十年中使心脏骤停（CA）的存活率翻了一番（从 16%至33%）。心脏停止跳动数分钟的病人现在被复苏，保存在一个医疗中心。 诱发昏迷，并将他们的身体冷却到89°- 93°F（以减少脑损伤），导致更多的CA 幸存者回归完整的生活然而，CA患者发生主要不良反应的风险仍然显著升高， 心血管事件（MACE）和全因死亡率（ACM），许多人报告与健康相关的不良质量， 生活质量（HRQoL）在CA后的一年-尽管恢复独立（通常是工作）与认知完好。 我们建议心脏焦虑（即，心脏特异性-恐惧、回避行为和过度心脏症状 监测）可能部分解释MACE/ACM风险和HRQOL差。它在CA患者中非常普遍， 在非CA心血管疾病（CVD）患者中显示与较高的CVD发生率相关- 相关的痛苦，避免体力活动，患者报告的残疾，以及健康状况差。 我们将建立一个前瞻性的CA幸存者队列，全面评估心脏焦虑和其他 CA的心理和行为后果在第一年的生存，并估计协会 心脏焦虑、体力活动和睡眠，随后发生MACE/ACM和HRQoL。我们将招收一名 246例CA住院患者的队列，在入组时评估心理和HRQoL指标，并在1，6， 还有12个月我们将在出院后2周内通过腕动计评估身体活动和睡眠， 在6个月随访前2周，并随访参与者12个月至MACE/ACM。这将是 这是第一个关于CA生存率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 校正一般心理困扰和其他重要临床协变量后的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后的心脏焦虑是否是 与出院后不久的低体力活动和/或短睡眠相关。体力活动（PA）和睡眠 与CVD风险和慢性疾病进展有关，但没有研究评估CA中的PA或睡眠 幸存者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 因为它引起威胁性的生理信号（即，心率加快、呼吸急促），以及 因心脏焦虑而失眠。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，并介导心脏焦虑与12个月MACE/ACM之间的关联 出院后的CA。通过确定可延展的干预目标来改善CVD/死亡风险， CA后的生活质量，这项研究可以点燃第一代CA生存率的发展 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.