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

最近的研究认为，某些性格优势（CS）可以为未来的战略， 公共卫生和个性化，以病人为中心的护理（PCC）在美国;迄今为止， 健康提供者很少关注可改变的患者心理优势， 利用它来改善患者-提供者的协作护理。除了医疗风险因素， 某些心理社会因素（例如，抑郁症）与心脏病（HD）死亡率相关， 死亡的主要原因，尤其是在晚年。最近的研究，主要是在普通人群中， 我发现某些CS对健康有益，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， 持续时间和缺乏医学混杂因素的信息。显然，还需要更多的临床研究 为CS在HD患者中的长期疗效提供可靠和有力的证据。心脏直视 外科手术（OHS），一种挽救/延长HD生命的干预措施，可能是一种有压力的生活事件。Pl's (Ai)先前的研究表明某些CS的理想效果（例如，世俗的崇敬，乐观主义） 关于最佳恢复（例如，较短的住院时间和较低的抑郁）。到 迄今为止，没有关于CS在OHS后长期生存中的作用的信息。此外，本发明还 女性在OHS后可能会更糟（例如，心源性死亡率、术后生存率）和PI较早 工作表明某些CS中的性别/性别差异（例如，虔诚，私人祈祷应对）和 一些CS和合并症可以解释OHS后短期恢复的性别差异。它 尚不清楚CS-生存联系中是否存在性别差异，或者CS是否与 抑郁症作为男性和女性随时间推移的HD死亡风险的轨迹。为了增加科学 知识，并告知最佳的心脏PCC，这项跨学科研究将评估 心理CS对现有老年患者队列的长期生存影响， 前瞻性评估OHS前和OHS后30个月的随访结果（N=481，女性42%，年龄=63± 10岁）， OHS）。该研究旨在解决新的研究问题：1。有没有CS预测 OHS后患者的长期生存（超过十年），调整已知的预测因子（例如， 人口统计学、抑郁症、医学混杂因素）？2. CSs的效果是否存在性别差异 在战后的生存状况3. CS如何减轻抑郁症的有害影响， HD死亡风险？ 为了实现我们预期的特定目标，我们将对组合的 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， 和来自胸外科医师协会（STS）国家数据库的患者信息， 以及一些应激反应敏感的生物标志物。这项研究是创新的，因为它将 第一个评估调整适当混杂因素后CS的长期生存效果 以及接受OHS的患者的性别差异。 通过结合来自多个数据的信息 Pl已经创建了一个特征良好的队列，将提供一个独特的机会， 解决现有文献中的方法学挑战，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.