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

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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.