The Role of Psychological Strength Factors in Long-term Survival of Older Adults with Advanced Heart Diseases, Requesting Open-heart Surgery, & Underlying Mechanisms

最近的研究假设，某些性格优势(CS)可以为两者未来的策略提供信息 美国的公共卫生和个性化、以患者为中心的护理(PCC)；但到目前为止， 卫生保健提供者很少注意到可改变的患者心理强度，这些心理强度可能是 以改善患者与提供者之间的协作护理。除了医疗风险因素外， 某些心理社会因素(例如，抑郁)与心脏病(HD)死亡率有关， 主要死因，尤其是在晚年。最近的研究，主要是在普通人群中进行的， 发现某些CS对健康有好处，尤其值得注意的是乐观的生存效果 和灵性指标。然而，这些研究受到规模小、研究时间短的限制。 持续时间，以及缺乏关于医学混杂因素的信息。显然，还需要更多的临床研究。 目的：为慢性肾功能衰竭患者应用CS的远期疗效提供可靠可靠的证据。敞开心扉 外科手术(OHS)是一种挽救/延长HD生命的干预措施，可能是一件压力很大的生活事件。PL‘s (AI)先前的研究表明，某些社会认同的可取效果(例如，世俗敬畏、乐观) 关于OHS后30个月的最佳康复(例如，较短的住院时间和较低的抑郁)。至 到目前为止，还没有关于CS在OHS后长期生存中的作用的信息。此外， 在OHS之后，女性的情况可能会更糟(例如，心脏死亡率、停药后存活率)，以及更早的PL 工作表明性别/性别在某些应对方式(如敬畏、私下祈祷应对)上的差异 一些CS和合并症可以解释OHS后短期康复中的性别差异。它 目前尚不清楚CS-存活链中是否存在性别差异，或者CS是否与 随着时间的推移，抑郁症作为HD-死亡风险在男性和女性中的轨迹。要添加科学的 这项跨学科研究将评估 心理CS在现有老年患者队列中的长期生存效果， OHS前和OHS后30个月的前瞻性评估(N=481，女性42%，年龄=63± 在OHS)。这项拟议的研究旨在解决新的研究问题：1.任何CSS预测 OHS患者的长期生存(超过十年)，调整已知预测因素(例如， 人口学、抑郁症、医学混杂因素)？2.社交网站的效果是否存在性别差异？ 关于OHS后的存活率？3.CS如何减轻众所周知的抑郁症的有害影响 HD-死亡风险？ 为了实现我们预期的特定目标，我们将对合并后的 国家死亡指数(NDI)记录，从前瞻性调查中获得的现有跨学科信息， 和患者级别的信息，来自胸科外科医生协会(STS)国家数据库，如 以及一些压力敏感的生物标记物。这项研究具有创新性，因为它将 第一个评估调整了适当混杂因素的CS的长期生存效果 以及OHS患者的性别差异。通过组合来自多个数据的信息 消息来源，PL已经创建了一个特征良好的队列，这将提供一个独特的机会 解决现有文献中的方法挑战，填补重要空白。

Recent work posits that certain character strengths (CS) could inform future strategies for both public health and individualized, patient-centered care (PCC) in the United States; yet to date, health providers pay little attention to modifiable patient psychological strengths that could be harnessed to improve the patient-provider collaborative care. In addition to medical risk factors, certain psychosocial factors (e.g., depression) are associated with heart disease (HD) mortality, a leading cause of death, especially in late life. Recent studies, mostly in general populations, have found health benefits of certain CSs, especially notable is the survival effect of optimism and spirituality indicators. These studies, however, are limited by small size, short study duration, and lack of information on medical confounders. Clearly, more clinical research is needed to provide reliable and robust evidence on the long-term effect of CSs in HD patients. Open-heart surgery (OHS), a life­ saving/extending intervention for HD, can be a stressful life event. Pl's (Ai) prior research showed the desirable effect of certain CSs (e.g., secular reverence, optimism) on optimal recovery (e.g., shorter hospitalization and low depression) in 30 months after OHS. To date, no information is available about the role of CS in post-OHS long-term survival. Further, women may fare worse after OHS (e.g., cardiac mortality, postop survival), and the Pl's earlier work indicates sex/gender differences in certain CSs (e.g., reverence, private prayer coping) and that some CSs and comorbidities could explain sex differences in post-OHS short-term recovery. It is not yet known if a sex difference in the CS-survival link exists, or if CSs interact with the trajectory of depression as a HD-mortality risk over time in men and women. To add scientific knowledge and to inform optimal cardiac PCC, this interdisciplinary study will evaluate the long-term survival effect of psychological CSs in an existing cohort of older patients, prospectively evaluated before OHS and followed for 30-months post OHS (N=481, female 42%, age=63± at OHS). The proposed study aims to address novel research questions: 1. Does any CSs predict long-term survival (over one decade) in patients following OHS, adjusting known predictors (e.g., demographics, depression, medical confounders)? 2. Are there sex differences in the effects of CSs on post­ OHS survival? 3. How does a CS mitigate the detrimental effect of depression as a known HD-mortality risk? To achieve our intended specific aims, we will perform multivariate analyses of the combined National Index of Death (NDI) records, existing interdisciplinary information obtained from prospective surveys, and patient­ level information from the Society of Thoracic Surgeons' (STS) national database, as well as some stress­ sensitive biomarkers, of this cohort. The study is innovative because it will be the first to evaluate the long-term survival effect of CSs adjusted for appropriate confounders and for sex differences in patients undergoing OHS. By combining information from multiple data sources, Pl has created a well-characterized cohort that will provide a unique opportunity to address methodological challenges in existing literature and fill important gaps.