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

心脏骤停后长期恢复的积极和消极心理预测因素

• 批准号: 10542763
• 负责人: Jeffrey Lee Birk
• 金额: $ 74.43万
• 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: 2021-01-05 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542763
• 关键词: Activities of Daily Living; Acute; Affect; American Heart Association; Autonomic nervous system; Awareness; Behavior; Behavioral Mechanisms; Behavioral Medicine; Belief; Cardiac; Cardiac Death; Cardiac health; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Characteristics; Chest; Clinical Practice Guideline; Dangerousness; Development; Disease; Distress; Ecological momentary assessment; Enrollment; Event; Frequencies; Future; Happiness; Health; Health Campaign; Healthcare; Heart; Heart Arrest; Hospitalization; Hospitals; Hour; Human; Impairment; Implantable Defibrillators; Implantation procedure; Inpatients; Intensive Care Units; Intervention; Life; Link; Literature; Long-Term Survivors; Measures; Medical; Mental Depression; Methods; Monitor; Myocardial Infarction; Neurologic; New York; Outcome; Participant; Patients; Persons; Physical activity; Population; Post-Traumatic Stress Disorders; Predictive Factor; Presbyterian Church; Psyche structure; Psychological Factors; Psychological Tests; Public Health; Quality of life; Recording of previous events; Recovery; Reporting; Research; Resources; Risk; Risk Factors; Role; Sampling; Shapes; Stroke; Surveys; Survival Rate; Survivors; Symptoms; System; Telephone; Testing; Ventricular Arrhythmia; Work; Wrist; actigraphy; acute care; cardioprotection; cardiovascular disorder risk; cohort; depressive symptoms; disability; ethnic diversity; experience; follow up assessment; health related quality of life; heart rate variability; heart rhythm; improved; indexing; infancy; interest; long term recovery; mortality; mortality risk; negative affect; observational cohort study; optimism; patient population; patient screening; prevent; primary outcome; prospective; psychologic; psychological distress; psychosocial; racial diversity; recruit; risk prediction; sudden cardiac death; survivorship

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.

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 在过去十年中增加了一倍多。然而，正如科学声明所强调的那样 美国心脏协会 2020 年 CA 患者长期恢复不良的风险仍显着升高 出院后。我们已经证明，CA 的经历可能是一种心理上令人痛苦的事件 导致 30% 以上的患者出现抑郁和创伤后应激障碍 (PTSD) 症状。更远， 这些症状与继发性心血管疾病 (CVD) 风险增加三倍相关 我们之前的工作中存在死亡风险。尽管人们对进行心理干预越来越感兴趣，但 没有可靠的方法来预防急性心脏事件后的负面心理因素（NPF）。关键的是， 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、 不良心血管事件较少，心血管疾病患者的死亡风险较低。这方面最有前途的PPF 尊重是一种乐观的感觉、积极情感的体验以及相信一个人的生活即使在 严重心脏事件后经常出现的抑郁和痛苦的表情。不知道CA是否 幸存者可能会像其他 CVD 患者一样从 PPF 中受益。尽管费率 CA 后患者的 NPF 升高甚至高于心脏病发作和中风后的患者，许多 CA 幸存者实际上报告了一种积极的态度，并相信他们有一个偶然的机会“第二次” 人生的机会。”本研究的首要目的是测试 PPF 和 NPF 是否与以下措施相关： CA 后一年内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化样本。第二个目的是测试 PPF 和 NPF 是否 与恢复背后的潜在行为机制相关：首先身体活动的变化 CA 后 6 个月。第三个目标是确定预测谁的人口和医疗因素 CA 后出现 PPF 和 NPF。我们将招募来自重症监护病房 (ICU) 的 228 名 CA 患者 纽约长老会医院。我们将评估患者出院时的 PPF 和 NPF（中位 21 天） CA 后）。我们将在 CA 后 3、6 和 12 个月通过电话进行后续评估。本周内 出院后立即以及 6 个月后，我们将通过手腕监测身体活动 佩戴的体动记录仪、使用移动生态瞬时评估的日常积极和消极情绪以及心脏 通过胸部贴片控制迷走神经。 CA 占所有心脏死亡的一半以上，是第三大原因 美国死亡和残疾的原因。可塑性 PPF 和 NPF 可能是改善生活质量和 让 CA 幸存者回归独立生活。这项研究将是第一个测试潜在心脏保护作用的研究 PPF 和潜在有害的 NPF 来研究如何改善 CA 后的长期恢复。