Positive and Negative Psychological Predictors of Long-Term Recovery after Cardiac Arrest

随着医疗保健的进步和有效的公共卫生活动，心脏骤停(CA)后的存活率 在过去的十年里翻了一番多。然而，正如一份科学声明所强调的那样， 美国心脏协会2020年，CA患者长期康复不良的风险仍显著增加 出院后。我们已经证明，CA的经历可能是一件令人痛苦的心理事件 这会导致30%的患者出现抑郁和创伤后应激障碍(PTSD)症状。此外， 这些症状与继发性心血管疾病(CVD)的风险增加三倍有关 我们先前工作中的死亡风险。尽管人们对进行心理干预的兴趣与日俱增，但 没有可靠的方法来预防急性心脏事件后的负性心理因素(NPF)。关键是， 可修改的积极心理因素(PPF)与生活质量(QOL)的改善有关， 日常生活活动(ADL)的独立性，更健康的行为，改善(更高)的心脏迷走神经控制， 心血管疾病患者的不良心血管事件较少，死亡风险较低。在这方面最有希望的PPF 尊重是一种乐观的感觉，是一种积极情感的体验，是一种信念，即一个人的生活即使在 经常伴随严重心脏事件而来的抑郁和苦恼的面孔。目前尚不清楚CA是否 幸存者可能会像其他心血管疾病患者一样从PPF中受益。尽管这一比率 CA后NPF的升高甚至高于心脏病发作和中风后的患者，许多CA 幸存者实际上报告了一种积极的态度和信念，认为他们有一秒钟的偶然机会 人生的机会。“这项研究的第一个目的是测试PPF和NPF是否与 对患者日常生活最重要的康复-生活质量和日常生活能力-在CA术后一年 CA幸存者的种族和民族多样性样本。第二个目标是测试PPF和NPF是否 与潜在的行为机制相关的康复：第一次体力活动的变化 CA术后6个月。第三个目标是确定人口统计学和医学因素来预测 在CA之后发展PPF和NPF。我们将从重症监护病房(ICU)招募228名CA患者 纽约长老会医院的。我们将在出院时(中位数21天)评估患者的PPF和NPF 后CA)。我们将在CA后3个月、6个月和12个月通过电话进行后续评估。在一周内 出院后立即和6个月后，我们将通过手腕监测体力活动- 佩戴的运动描记，使用流动生态瞬时评估的日常积极和消极影响，以及心脏 通过胸部贴片控制迷走神经。CA占所有心脏死亡的一半以上，是第三大死因 在美国的死亡和残疾原因。可延展性PPF和NPF可能是改善QOL和 让CA幸存者回归独立生活。这项研究将是第一次测试潜在的心脏保护作用 PPF和潜在有害的NPF，以研究如何改善CA后的长期恢复。

With advances in healthcare and effective public health campaigns, the survival rate after cardiac arrest (CA) has more than doubled during the last decade. However, as highlighted by a scientific statement from the American Heart Association in 2020, CA patients remain at markedly elevated risk for poor long-term recovery after leaving the hospital. We have shown that the experience of CA can be a psychologically distressing event that induces depressive and posttraumatic stress disorder (PTSD) symptoms in >30% of patients. Further, these symptoms were associated with a tripling of risk for secondary cardiovascular disease (CVD) and mortality risk in our prior work. Despite a growing interest in conducting psychological interventions, there is no reliable method for preventing negative psychological factors (NPF) after acute cardiac events. Critically, modifiable positive psychological factors (PPF) are associated with improved quality of life (QoL), greater independence in activities of daily living (ADL), healthier behaviors, improved (higher) cardiac vagal control, fewer adverse cardiovascular events, and lower risk of dying in CVD patients. The most promising PPF in this regard are a sense of optimism, experiences of positive affect, and a belief that one’s life has purpose even in the face of the depression and distress that often follow serious cardiac events. It is unknown whether CA survivors may benefit from PPF in the same way as other CVD patients seem to do. Although the rates of elevated NPF are even higher in patients after CA than in patients after heart attack and stroke, many CA survivors actually report a positive attitude and a belief that they have a fortuitous opportunity for “a second chance at life.” The first aim of the study is to test whether PPF and NPF are associated with the measures of recovery that are most important to patients’ everyday lives—QoL and ADL—in the year after the CA in a racially and ethnically diverse sample of CA survivors. The second aim is to test whether PPF and NPF are associated with a potential behavioral mechanism underlying recovery: changes in physical activity in the first 6 months after the CA. The third aim is to determine the demographic and medical factors that predict who develops PPF and NPF after CA. We will enroll a cohort of 228 CA patients from the intensive care units (ICU) of NewYork-Presbyterian Hospital. We will assess patients’ PPF and NPF at hospital discharge (median 21 days post-CA). We will conduct follow-up assessments by phone at 3, 6, and 12 months after the CA. In the week immediately following hospital discharge and again 6 months later, we will monitor physical activity via wrist- worn actigraphy, daily positive and negative affect using mobile ecological momentary assessment, and cardiac vagal control via a chest patch. CA accounts for more than half of all cardiac deaths, and is the third leading cause of death and disability in the US. Malleable PPF and NPF may be targets for improving QoL and returning CA survivors to independent lives. This study will be the first to test the potentially cardioprotective PPF and the potentially harmful NPF to investigate how long-term recovery after CA may be improved.