Investigating fear of recurrence as a modifiable mechanism of behavior change to improve medication adherence in acute coronary syndrome patients

急性冠脉综合征(ACS；心肌梗死或不稳定型心绞痛)是 美国的发病率和死亡率为每年100万例。幸存者面临着很高的风险 反复发生的心血管疾病(CVD)事件，特别是如果他们不遵守风险- 减少用药。不幸的是，在急性冠脉综合征患者中不坚持治疗是非常常见的。 (约50%)，而且不存在有效的、可扩展的干预措施。解决用药不依从性问题 急性冠脉综合征患者需要一种实验医学方法来确定其具体机制 那些与这些机制最相关和最可修改的人群的行为变化。 越来越多的证据表明，许多患有创伤后应激障碍的患者 急性冠脉综合征后的精神障碍(PTSD)症状将他们的药物视为对他们心脏的提醒 事件和他们未来的心血管疾病风险。具有讽刺意味的是，尽管很少有人在癌症之外对其进行研究 幸存者，这种对复发的恐惧可能会破坏ACS患者的用药依从性。 该项目将使用行为改变科学(SOBC)实验医学方法来 研究阿司匹林依从性行为改变的可能机制 在出院时有早期创伤后应激障碍症状的ACS患者中。我们将测试一种认知- 情感干预已被证明可减少癌症幸存者的风险，即提供 患者家中的电子设备(IPad)。我们已经开始调整这种干预措施以适应急性冠脉综合征， 并将采用双盲随机对照设计进行试验。我们将招收n=100名ACS 出院时有高度急性应激障碍症状的患者，并评估未来的时间 在住院患者床边观察，然后对参与者进行iPad干预培训。参与者 将在四周内完成干预，每周两次，共八次，每次半小时。 服药依从性将使用eCAP进行电子测量。我们将重新评估和 1个月随访时的未来时间视角，以及电子评估认知-情感 在整个干预期内发生了变化。 我们将评估急性冠脉综合征诱发的创伤后应激障碍与未来时间的关系，以及 他们与服药依从性的关系。然后，我们将评估干预是否 已成功接合目标机构(用于)。最后，我们将测试干预是否 在出院后2个月内改善依从性，以及是否有任何干预措施 影响是由于For的减少。这将是第一项确定并可能修改一项 急性冠脉综合征高危患者遵医行为的认知/情感机制 复发和死亡率。

Acute coronary syndrome (ACS; myocardial infarction or unstable angina) is a leading cause of morbidity and mortality in the U.S., with >1 million cases per year. Survivors are at high risk for recurrent cardiovascular disease (CVD) events, particularly if they do not adhere to risk- reducing medications. Unfortunately, nonadherence among ACS patients is very common (~50%), and no effective, scalable interventions exist. Addressing medication nonadherence in ACS patients requires an experimental medicine approach to identify specific mechanisms of behavior change in populations for whom those mechanisms are most relevant and modifiable. Accumulating evidence suggests that the many patients who develop post-traumatic stress disorder (PTSD) symptoms following ACS view their medications as reminders of their cardiac event and their future CVD risk. Ironically, although it has rarely been studied outside of cancer survivors, this fear of recurrence (FoR) may undermine medication adherence in ACS patients. This project will use the Science of Behavior Change (SOBC) experimental medicine approach to investigate FoR as a putative mechanism of behavior change with respect to aspirin adherence among ACS patients with early PTSD symptoms at hospital discharge. We will test a cognitive- affective intervention that has been shown to reduce FoR in cancer survivors, that is delivered electronically (IPad) in the patient’s home. We have begun adapting this intervention for ACS, and will test it using a double-blind randomized controlled design. We will enroll n=100 ACS patients with high acute stress disorder symptoms at discharge, and assess FoR and future time perspective at inpatient bedside, then train participants on the IPad intervention. Participants will complete the intervention over four weeks in eight half-hour sessions, twice each week. Medication adherence will be measured electronically using eCAPS. We will reassess FoR and future time perspective at 1 month follow up, as well as electronically assess cognitive-affective change throughout the intervention period. We will estimate associations among ACS-induced PTSD, FoR, and future time perspective, and their association with medication adherence. Then, we will assess whether the intervention successfully engages the target mechanism (FoR). Finally, we will test whether the intervention improves adherence in the 2 months after hospital discharge, and whether any intervention effect is due to reduction in FoR. This will be the first study to identify, and perhaps modify, a cognitive/affective mechanism of adherence behavior in ACS patients at high risk for ACS recurrence and mortality.