Perceived Social Support, Heart Rate Variability, and Hopelessness in Patients with Ischemic Heart Disease

心血管疾病是全球主要的死亡原因，其中缺血性心脏病(IHD)是 心血管疾病死亡的主要原因。患有精神疾病的人，包括 无望的人更有可能死于IHD。在应激事件之后，迷走神经能够激活 指交感神经(战斗/逃跑)或副交感神经(休息/消化)反应。心率变异性(HRV)， 正常连续心脏搏动之间的搏动变异性是适应性和 对压力的不适应反应。心率变异性降低预示着发病率和死亡率的更大风险 与IHD患者的心理健康状况不佳有关。根据多发性迷走神经理论，心率变异性可能是 受社会支持的影响。领悟到的社会支持(PSS)减少，这是心血管疾病的社会决定因素 风险，预示着IHD患者发病率和死亡率的增加。PSS已降低 与癌症患者的绝望有关，但这种关系还没有在IHD Beyond中进行研究 申请者对绝望患者的小型先导性研究。绝望、悲观的观点和 27-52%的IHD患者对未来感到无助。这一点令人严重关切，因为 无望与死亡和非致命性心肌梗死风险增加3.4倍相关 IHD患者，独立于抑郁症。这项研究的重点是了解生物(HRV) 和社会(PSS)方面的绝望，长期目标是开发和测试小说 减少绝望感的不良影响和改善IHD患者健康结局的干预措施。 这项横断面研究的参与者将在因IHD活动住院期间被招募。参与者将 包括从赞助者的NIH资助的研究中报告中度到严重绝望的患者(n=225)； 申请者将招募更多绝望程度最低或没有绝望的患者(n=45)。 数据收集将在出院两周后远程进行。申请者的培训目标是 专注于IHD病理生理学；HRV科学和测量；研究设计， 方法、行为和分析技术；以及团队科学。研究培训将在 伊利诺伊大学芝加哥分校丰富的科学环境。具体目标包括：目标1)评估 心率变异性与IHD患者绝望感的关系 PSS与IHD患者的绝望感；以及目的3)探讨心率变异性对IHD患者PSS和绝望的可能中介作用 IHD患者PSS与绝望感的关系这项拟议研究的结果和 培训计划将使申请者做好准备，启动一项专注于生物和社会研究的计划 IHD患者症状的动态变化。拟议的研究通过以下方式支持NINR的使命 解决症状科学领域的一个重要问题：促进个性化健康战略 长期目标是促进IHD患者的个性化健康治疗。

Cardiovascular disease is the leading cause of death worldwide, with ischemic heart disease (IHD) the leading cause of cardiovascular mortality. Persons with IHD suffering from psychological distress, including hopelessness, are more likely to die from IHD. Following a stressful event, the vagus nerve enables activation of either a sympathetic (fight/flight) or parasympathetic (rest/digest) response. Heart rate variability (HRV), the beat-to-beat variability between normal successive heart beats, is a biomarker of both adaptive and maladaptive reactions to stress. Decreased HRV predicts greater risk for morbidity and mortality and is associated with poor mental health outcomes in persons with IHD. As stated by polyvagal theory, HRV may be influenced by social support. Decreased perceived social support (PSS), a social determinant of cardiovascular risk, is predictive of increased morbidity and mortality in persons with IHD. Decreased PSS has been associated with hopelessness in patients with cancer, but this relationship has not been studied in IHD beyond the applicant’s small pilot study of patients with hopelessness. Hopelessness, a negative outlook and sense of helplessness about the future, is present in 27-52% of patients with IHD. This is of grave concern, because hopelessness is associated with a 3.4 times increased risk of mortality and nonfatal myocardial infarction in patients with IHD, independent of depression. This research focuses on understanding the biological (HRV) and social (PSS) aspects of hopelessness, with the long-term goal of developing and testing novel interventions to reduce the adverse effects of hopelessness and improve health outcomes in patients with IHD. Participants for this cross-sectional study will be recruited while hospitalized for an IHD event. Participants will include patients who report moderate to severe hopelessness from the sponsor’s NIH-funded study (n = 225); additional patients with minimal to no hopelessness will be recruited and enrolled by the applicant (n = 45). Data collection will take place remotely two weeks after hospital discharge. The applicant’s training goals are focused on a strong foundation in IHD pathophysiology; HRV science and measurement; research design, methods, conduct, and analytical techniques; and team science. The research training will take place in the rich scientific environment at the University of Illinois Chicago. Specific aims include: Aim 1) Evaluate the relationship between HRV and hopelessness in patients with IHD; Aim 2) Determine the relationship between PSS and hopelessness in patients with IHD; and Aim 3) Explore the possible mediating effect of HRV on the relationship between PSS and hopelessness in patients with IHD. The outcomes of this proposed study and the training plan will prepare the applicant to launch a program of research focused on the biological and social dynamics of symptoms experienced in patients with IHD. The proposed research supports NINR’s mission by addressing an important issue within the area of Symptom Science: Promoting Personalized Health Strategies with a long-term goal of promoting personalized health treatments for persons with IHD.