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

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.

Grant Number: 5R01HL151850-05
NIH Institute/Center: NIH
Principal Investigator: Jeffrey Birk