Advances in healthcare, and effective public health campaigns to disseminate cardiopulmonary resuscitation (CPR) and portable defibrillators have doubled the survival rate for cardiac arrest (CA) in the last decade (from 15% to >35%). Patients whose hearts stop beating for many minutes are now resuscitated, kept in a medically- induced coma, and have their bodies cooled to 89- 93F (to reduce brain damage during reperfusion)? resulting in many more CA survivors returning to full lives. However, CA patients remain at markedly elevated risk for major adverse cardiac events (MACE) and all-cause mortality (ACM), and many report poor health- related quality of life (HRQoL) in the year after CA--despite returning to independent living (and often return to work) with cognition intact. We will build a prospective cohort of CA survivors, comprehensively assess the psychological and behavioral consequences of CA in the first year of survivorship and estimate the association of psychological and behavioral factors with subsequent MACE/ACM and HRQoL. We will enroll a cohort of 246 CA inpatients from NY Presbyterian Hospital, assess psychological factors at inpatient enrollment and by telephone at 1, 6, and 12 months after discharge. We will assess physical activity and sleep by actigraphy for 45 days and follow participants for 1-year to MACE/ACM and HRQoL. The proposed research would be the first major prospective cohort study of CA survivorship, and the first to objectively assess health behavior in the weeks after discharge. We have shown that CA can be a traumatic experience; >30% of CA patients screen positive for posttraumatic stress disorder (PTSD) due to the CA. Further, CA-induced PTSD was associated with a tripling of risk for 1- year MACE/ACM in our self-funded pilot. However, the small sample size (n=114) for that pilot finding, and our inability to adjust for depression, general anxiety, and cardiac-specific anxiety, led us to propose our first Aim: to replicate the PTSD-MACE/ACM finding with adjustment for confounders, and test for unique effects of PTSD and other psychological factors on HRQoL. Further, we will test the role of health behaviors in long-term CA prognosis. Physical activity (PA) and sleep are implicated in CVD risk and chronic disease progression, but no study has assessed PA or sleep in CA survivors. We have found that survivors of other acute cardiac events report avoiding physical activity because it causes threatening physiological signals (i.e., increased heart rate, shortness of breath), and poor sleep due to cardiac anxiety.
Our second aim i s to test whether poor PA and sleep prospectively predict CVD/mortality risk and poor HRQoL. This study will be the first to estimate the unique contributions of psychological and behavioral factors to 1-year CVD/mortality risk and HRQoL. We will also explore temporal associations among psychology, behavior, HRQoL, and CVD/mortality risk. By identifying malleable intervention targets for improving both CVD/mortality risk and post-CA quality of life, this study could ignite the development of the first generation of CA survivorship interventions.
Many cardiac arrest (CA) patients now survive neurologically intact, but evidence from the new field of CA survivorship research suggests that psychological distress, physical inactivity, and poor sleep are common?and may undermine CA survivors' quality of life and further increase their high cardiovascular and mortality risk. This will be the first cohort study of CA survivors followed from inpatient care through 1 year, to comprehensively assess psychological distress, objectively monitor physical activity and sleep, and rigorously adjudicate cardiovascular events and mortality. We will estimate the prospective association of psychological and behavioral factors with 1-year prognosis and quality of life, to identify intervention targets and offer empirical evidence for their inclusion in clinical practice guidelines.
