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.

项目摘要：许多患者现在在院外心脏骤停（OHCA）中生存，但是差距关于长期结局的知识导致零散且欠发达的护理连续体以实现恢复。恢复被定义为功能和认知结果的显着改善，健康 - 相关生活质量（HRQOL）。具有良好恢复模式的OHCA幸存者可能会返回工作和/或社会角色。在OHCA后评估恢复域的先前研究很小，仅限于单个中心和短期成果，即1-3个月。识别单个患者康复模式长期，预测谁在出院后可能需要更密集的支持的能力将允许对干预措施更有效。我们为患者及其家人提供即使没有可修改的情况，有关患者的前景的最佳信息，即使干预目标。这项研究将是第一个专注于OHCA新的公平科学的研究生存本身，寻求凭经验得出的目标来保存或恢复恢复。我们的单中心试点研究发现，将近三分之一的OHCA幸存者具有临床上重要的长期（12个月）和短期（3个月）功能结果之间的差异，间隔很大恢复的个体变异性（即改善或恶化）。我们发现住院急性康复与其他处置相比，在12个月时在12个月时的功能恢复模式相关，但是黑色种族和西班牙裔/拉丁裔的恢复模式比非西班牙裔白人差。为了填补这一空白，我们提出了对NINDS/NHLBI资助的ICECAP试验进行的辅助研究 NIH急诊试验网络的60个地点，以描述恢复（功能结果[主要]，认知和HRQOL结果[次要]）美国OHCA患者的代表队列。我们将注册n = 1,000，他们被筛选为ICECAP和生存到医院出院。父母ICECAP试验包括1个月的电话随访和一个三个月的面对面访问。辅助研究将在6和9中添加两次电话/视频会议访问几个月和在OHCA后12个月内进行面对面的访问。对于AIM 1，我们将描述恢复患者之间的变异性（即，功能，认知的改善，和HRQOL结果）从OHCA后3到12个月，并测试是否与疾病有关严重程度的评分和急性护理期间的重症监护干预措施。 AIM 2将测试是否在1个月内收到急性住院康复（与门诊治疗/无疗法/熟练护理设施）医院出院的恢复效果从3个月提高了。最后，在AIM 3中，我们将测试非西班牙裔黑人和西班牙裔/拉丁裔患者的有利恢复结果的变化在3到12个月之间，并探讨了这种差异的机制。