Positive and Negative Psychological Predictors of Long-Term Recovery after Cardiac Arrest

随着医疗保健的进步和有效的公共卫生运动，心脏骤停（CA）后的存活率 在过去的十年里翻了一倍多。然而，正如一份科学声明所强调的那样， 美国心脏协会在2020年，CA患者长期恢复不良的风险仍显着升高 在离开医院后。我们已经表明，CA的经验可以是一个心理上痛苦的事件 在>30%的患者中引起抑郁和创伤后应激障碍（PTSD）症状。此外，本发明还 这些症状与继发性心血管疾病（CVD）风险的三倍相关， 在我们之前的工作中死亡风险。尽管对心理干预的兴趣越来越大， 急性心脏事件后无可靠的预防负性心理因素（NPF）方法。关键是， 可改变的积极心理因素（PPF）与生活质量（QoL）的改善相关， 日常生活活动（ADL）的独立性，更健康的行为，改善（更高）的心脏迷走神经控制， 心血管不良事件较少，CVD患者死亡风险较低。这一领域最有前途的PPF 尊重是一种乐观的感觉，积极的情感体验，以及一种相信一个人的生活即使在 面对严重心脏病事件后的抑郁和痛苦。目前尚不清楚， 幸存者可能受益于PPF的方式与其他CVD患者似乎一样。虽然， CA后患者的NPF升高甚至高于心脏病发作和中风后患者，许多CA 幸存者实际上报告了一种积极的态度，并相信他们有一个“第二次”的偶然机会。 生命的机会”。本研究的第一个目的是检验PPF和NPF是否与以下指标相关： 在CA后一年中，对患者日常生活最重要的恢复-QoL和ADL- CA幸存者的种族和民族多样性样本。第二个目的是测试PPF和NPF是否 与潜在的行为机制相关的恢复：在第一个身体活动的变化， CA后6个月。第三个目标是确定预测谁的人口统计学和医学因素 在CA之后发展PPF和NPF。我们将从重症监护室（ICU）招募228名CA患者 纽约长老会医院我们将在出院时（中位数21天）评估患者的PPF和NPF 后CA）。我们将在CA后3个月、6个月和12个月通过电话进行随访评估。当周 出院后立即和6个月后再次，我们将通过手腕监测身体活动- 穿戴式体动记录仪，使用移动的生态瞬时评估的每日积极和消极影响，以及心脏 通过胸贴控制迷走神经CA占所有心脏病死亡的一半以上，是第三大心脏病死亡原因。 在美国死亡和残疾的原因。可塑性PPF和NPF可能是改善QoL的目标， 让CA幸存者恢复独立生活。这项研究将是第一个测试潜在的心脏保护作用的研究。 PPF和潜在有害的NPF，以研究如何改善CA后的长期恢复。

With advances in healthcare and effective public health campaigns, the survival rate after cardiac arrest (CA) has more than doubled during the last decade. However, as highlighted by a scientific statement from the American Heart Association in 2020, CA patients remain at markedly elevated risk for poor long-term recovery after leaving the hospital. We have shown that the experience of CA can be a psychologically distressing event that induces depressive and posttraumatic stress disorder (PTSD) symptoms in >30% of patients. Further, these symptoms were associated with a tripling of risk for secondary cardiovascular disease (CVD) and mortality risk in our prior work. Despite a growing interest in conducting psychological interventions, there is no reliable method for preventing negative psychological factors (NPF) after acute cardiac events. Critically, modifiable positive psychological factors (PPF) are associated with improved quality of life (QoL), greater independence in activities of daily living (ADL), healthier behaviors, improved (higher) cardiac vagal control, fewer adverse cardiovascular events, and lower risk of dying in CVD patients. The most promising PPF in this regard are a sense of optimism, experiences of positive affect, and a belief that one’s life has purpose even in the face of the depression and distress that often follow serious cardiac events. It is unknown whether CA survivors may benefit from PPF in the same way as other CVD patients seem to do. Although the rates of elevated NPF are even higher in patients after CA than in patients after heart attack and stroke, many CA survivors actually report a positive attitude and a belief that they have a fortuitous opportunity for “a second chance at life.” The first aim of the study is to test whether PPF and NPF are associated with the measures of recovery that are most important to patients’ everyday lives—QoL and ADL—in the year after the CA in a racially and ethnically diverse sample of CA survivors. The second aim is to test whether PPF and NPF are associated with a potential behavioral mechanism underlying recovery: changes in physical activity in the first 6 months after the CA. The third aim is to determine the demographic and medical factors that predict who develops PPF and NPF after CA. We will enroll a cohort of 228 CA patients from the intensive care units (ICU) of NewYork-Presbyterian Hospital. We will assess patients’ PPF and NPF at hospital discharge (median 21 days post-CA). We will conduct follow-up assessments by phone at 3, 6, and 12 months after the CA. In the week immediately following hospital discharge and again 6 months later, we will monitor physical activity via wrist- worn actigraphy, daily positive and negative affect using mobile ecological momentary assessment, and cardiac vagal control via a chest patch. CA accounts for more than half of all cardiac deaths, and is the third leading cause of death and disability in the US. Malleable PPF and NPF may be targets for improving QoL and returning CA survivors to independent lives. This study will be the first to test the potentially cardioprotective PPF and the potentially harmful NPF to investigate how long-term recovery after CA may be improved.