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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.

项目总结：现在许多患者在院外心脏骤停（OHCA）中存活下来，但仍存在空白