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Rojas DA, Sayde GE, Vega JS, Tincher IM, Yuan M, Flanary K, Birk JL, Agarwal S. Associations between Post-Intensive Care Syndrome Domains in Cardiac Arrest Survivors and Their Families One Month Post-Event. J Clin Med 2024; 13:5266. [PMID: 39274479 PMCID: PMC11396683 DOI: 10.3390/jcm13175266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 08/31/2024] [Accepted: 09/01/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Post-intensive care syndrome (PICS) affects many critical care survivors and family members. Nevertheless, the relationship between PICS-relevant domains in cardiac arrest (CA) survivors and psychological distress in their family members (henceforth, PICS-F) remains underexplored. Methods: We enrolled consecutive CA patients admitted between 16 August 2021 and 28 June 2023 to an academic medical center, along with their close family members, in prospective studies. Survivors' PICS domains were: physical dependence (Physical Self-Maintenance Scale, PSMS), cognitive impairments (Modified Telephone Interview for Cognitive Status, TICS-M), and post-traumatic stress disorder (PTSS) symptoms (PTSD Checklist-PCL 5), as well as PICS-F (PCL-5 Total Score). Hierarchical multivariate linear regressions examined associations between PICS-F and survivors' PICS domains. Results: Of 74 dyads (n = 148), survivors had a mean (SD) age of 56 ± 16 years, with 61% being male and with a median hospital stay of 28 days. Family members (43% spouses) were slightly younger (52 ± 14 years), predominantly female (72%), and of minority race/ethnicity (62%). A high prevalence of PICS assessed 28.5 days (interquartile range 10-63) post-CA was observed in survivors (78% physical dependence, 54% cognitive impairment, 30% PTSS) and in family members (30% PTSS). Survivor PTSS was significantly associated with family member distress (β = 0.3, p = 0.02), independent of physical dependence (β = 0.0, p = 0.9), cognitive impairment (β = -0.1, p = 0.5), family member characteristics, and duration of hospitalization. Conclusions: Both CA survivors and their family members showed substantial evidence of likely PICS. Survivor PTSS is notably associated with family member distress, highlighting the need for dyadic interventions to enhance psychosocial outcomes.
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Affiliation(s)
- Danielle A Rojas
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - George E Sayde
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jason S Vega
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Isabella M Tincher
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Mina Yuan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Kristin Flanary
- Cardiac Arrest Family Member Stakeholder & Advocate, Glaucomflecken LLC, Eugene, OR 97401, USA
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Sachin Agarwal
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
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Tincher IM, Rojas DA, Abukhadra S, DeForge CE, Yuan M, Thomas SJ, Flanary K, Shimbo D, Makarem N, Chang BP, Agarwal S. Disruptions in Sleep Health and Independent Associations with Psychological Distress in Close Family Members of Cardiac Arrest Survivors: A Prospective Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.18.24309137. [PMID: 38946971 PMCID: PMC11213050 DOI: 10.1101/2024.06.18.24309137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background While recent guidelines have noted the deleterious effects of poor sleep on cardiovascular health, the upstream impact of cardiac arrest-induced psychological distress on sleep health metrics among families of cardiac arrest survivors remains unknown. Methods Sleep health of close family members of consecutive cardiac arrest patients admitted at an academic center (8/16/2021 - 6/28/2023) was self-reported on the Pittsburgh Sleep Quality Index (PSQI) scale. The baseline PSQI administered during hospitalization was cued to sleep in the month before cardiac arrest. It was then repeated one month after cardiac arrest, along with the Patient Health Questionnaire-8 (PHQ-8) to assess depression severity. Multivariable linear regressions estimated the associations of one-month total PHQ-8 scores with changes in global PSQI scores between baseline and one month with higher scores indicating deteriorations. A prioritization exercise of potential interventions categorized into family's information and well-being needs to alleviate psychological distress was conducted at one month. Results In our sample of 102 close family members (mean age 52±15 years, 70% female, 21% Black, 33% Hispanic), mean global PSQI scores showed a significant decline between baseline and one month after cardiac arrest (6.2±3.8 vs. 7.4±4.1; p<0.01). This deterioration was notable for sleep quality, duration, and daytime dysfunction components. Higher PHQ-8 scores were significantly associated with higher change in PSQI scores, after adjusting for family members' age, sex, race/ethnicity, and patient's discharge disposition [β=0.4 (95% C.I 0.24, 0.48); p<0.01]. Most (n=72, 76%) prioritized interventions supporting information over well-being needs to reduce psychological distress after cardiac arrest. Conclusions There was a significant decline in sleep health among close family members of cardiac arrest survivors in the acute phase following the event. Psychological distress was associated with this sleep disruption. Further investigation into their temporal associations is needed to develop targeted interventions to support families during this period of uncertainty. WHAT IS KNOWN Sleep health has been identified as a key element in maintaining cardiovascular health.Close family members of critically ill patients experience suboptimal sleep health and psychological distress may contribute to it. WHAT THE STUDY ADDS It is breaking new ground in understanding the sleep health dynamics of close family members of cardiac arrest survivors, a critical but often overlooked group of caregivers.The study highlights significant associations between psychological distress and poor sleep that further deteriorates within the first month after a loved one's cardiac arrest.Families of cardiac arrest survivors expressed a high priority for information-based interventions to help alleviate psychological distress during the initial month following the cardiac event emphasizing the need for targeted, accessible, resources to address their psychological and potentially sleep-related challenges.
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Coppler PJ, Brown M, Moschenross DM, Gopalan PR, Presciutti AM, Doshi AA, Sawyer KN, Frisch A, Callaway CW, Elmer J. Impact of Preexisting Depression and Anxiety on Hospital Readmission and Long-Term Survival After Cardiac Arrest. J Intensive Care Med 2024; 39:542-549. [PMID: 38073090 PMCID: PMC11090726 DOI: 10.1177/08850666231218963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND While sudden cardiac arrest (CA) survivors are at risk for developing psychiatric disorders, little is known about the impact of preexisting mental health conditions on long-term survival or postacute healthcare utilization. We examined the prevalence of preexisting psychiatric conditions in CA patients who survived hospital discharge, characterized incidence and reason for inpatient psychiatry consultation during these patients' acute hospitalizations, and determined the association of pre-CA depression and anxiety with hospital readmission rates and long-term survival. We hypothesized that prior depression or anxiety would be associated with higher hospital readmission rates and lower long-term survival. METHODS We conducted a retrospective cohort study including patients resuscitated from in- and out-of-hospital CA who survived both admission and discharge from a single hospital between January 1, 2010, and December 31, 2017. We identified patients from our prospective registry, then performed a structured chart review to abstract past psychiatric history, prescription medications for psychiatric conditions, and identify inpatient psychiatric consultations. We used administrative data to identify readmissions within 1 year and vital status through December 31, 2020. We used multivariable Cox regressions controlling for patient demographics, medical comorbidities, discharge Cerebral Performance Category and disposition, depression, and anxiety history to predict long-term survival and hospital readmission. RESULTS We included 684 subjects. Past depression or anxiety was noted in 24% (n = 162) and 19% (n = 129) of subjects. A minority of subjects (n = 139, 20%) received a psychiatry consultation during the index hospitalization. Overall, 262 (39%) subjects had at least 1 readmission within 1 year. Past depression was associated with an increased hazard of hospital readmission (hazard ratio 1.50, 95% CI 1.11-2.04), while past anxiety was not associated with readmission. Neither depression nor anxiety were independently associated with long-term survival. CONCLUSIONS Depression is an independent risk factor for hospital readmission in CA survivors.
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Affiliation(s)
- Patrick J. Coppler
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - McKenzie Brown
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Darcy M. Moschenross
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Priya R. Gopalan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander M. Presciutti
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ankur A. Doshi
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly N. Sawyer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adam Frisch
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clifton W. Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Neurology Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Presciutti AM, Enkhtsetseg N, Flickinger KL, Coppler PJ, Ratay C, Doshi AA, Perman SM, Vranceanu AM, Elmer J. Emotional distress, social support, and functional dependence predict readiness for hospital discharge in a prospective sample of cognitively intact cardiac arrest survivors. Resuscitation 2024; 198:110166. [PMID: 38452994 PMCID: PMC11088514 DOI: 10.1016/j.resuscitation.2024.110166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/28/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
AIM To inform screening, referral and treatment initiatives, we tested the hypothesis that emotional distress, social support, functional dependence, and cognitive impairment within 72 hours prior to discharge predict readiness for discharge in awake and alert cardiac arrest (CA) survivors. METHODS This was a secondary analysis of a prospective single-center cohort of CA survivors enrolled between 4/2021 and 9/2022. We quantified emotional distress using the Posttraumatic Stress Disorder Checklist-5 and PROMIS Emotional Distress - Anxiety and Depression Short Forms 4a; perceived social support using the ENRICHD Social Support Inventory; functional dependence using the modified Rankin Scale; and cognitive impairment using the Telephone Interview for Cognitive Status. Our primary outcome was readiness for discharge, measured using the Readiness for Hospital Discharge Scale. We used multivariable linear regression to test the independent association of each survivorship factor and readiness for discharge. RESULTS We included 110 patients (64% male, 88% white, mean age 59 [standard deviation ± 13.1 years]). Emotional distress, functional dependence, and social support were independently associated with readiness for discharge (adjusted β's [absolute value]: 0.25-0.30, all p < 0.05). CONCLUSIONS Hospital systems should consider implementing routine in-hospital screening for emotional distress, social support, and functional dependence for CA survivors who are awake, alert and approaching hospital discharge, and prioritize brief in hospital treatment or post-discharge referrals.
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Affiliation(s)
- Alexander M Presciutti
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, USA; Department of Psychiatry, Harvard Medical School, USA.
| | - Nomin Enkhtsetseg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, USA
| | | | - Patrick J Coppler
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA
| | - Cecelia Ratay
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA
| | - Ankur A Doshi
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA
| | - Sarah M Perman
- Department of Emergency Medicine, Yale University School of Medicine, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, USA; Department of Psychiatry, Harvard Medical School, USA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, USA; Department of Neurology, University of Pittsburgh School of Medicine, USA
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Agarwal S, Tincher IM, Abukhadra SL, Rojas DA, DeForge CE, Marchionda C, Wylie J, Chap J. Prioritizing intervention preferences to potentially reduce caregiver burden in racially and ethnically diverse close family members of cardiac arrest survivors. Resuscitation 2024; 194:110093. [PMID: 38122886 PMCID: PMC10843630 DOI: 10.1016/j.resuscitation.2023.110093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
AIM Close family members of cardiac arrest patients who survive to hospital discharge have elevated levels of psychological distress and caregiver burden. We assessed their preferences toward needs during hospitalization and beyond to inform intervention development. METHODS Through an online survey developed by a multidisciplinary team of researchers, clinicians, cardiac arrest survivors, and families, adult close family members recruited through advocacy organizations ranked top choice among 8 unique interventions addressing either information-based needs (n = 4) or well-being needs (n = 4). Logistic Regression analysis was conducted to assess the associations of family members' attributes, caregiving characteristics, and survivors' hospitalization factors with two intervention groups. RESULTS Of 657 responses received, ranking data of 550 close family members (59% between 18-40 years of age, 65% female, 51% of minority race/ethnicity, 53% partners, provided a median of 8 hours of caregiving, for a median of 4.5 months) were analyzed. Information needs were the more commonly preferred intervention group (63%; n = 347), with education on the potential recovery of survivors ranking first (28%; n = 149). In a multivariate model, family members age >40 years, families witnessing the cardiac arrest, assuming the caregiver role either during hospitalization or within one month of hospital discharge, and discharging directly to home were significantly associated with prioritizing information needs over well-being needs, after adjusting for sex, race, intensity, and duration of caregiving. CONCLUSIONS Interventions focusing on information needs are among the top priorities for families of cardiac arrest survivors. Prospective studies testing these hypotheses-generating findings are needed to inform further intervention development.
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Affiliation(s)
| | | | | | | | | | | | - Jasmine Wylie
- Sudden Cardiac Arrest Survivors Online Group, Survivor, USA
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El-Ashry AM, Elsayed SM, Ghoneam MA, Atta MHR. Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses' experiences. BMC Nurs 2023; 22:482. [PMID: 38110907 PMCID: PMC10726549 DOI: 10.1186/s12912-023-01640-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is considered one of the most stressful experiences in critical care nursing; it directly and indirectly leads to compassion fatigue and burnout. AIM Determine the levels of and relationship between postcode stress and compassion fatigue. DESIGN AND METHODS A descriptive-correlational study using 300 critical care nurses from five intensive care units in two hospitals was conducted. TOOLS Demographic and work-related data, the Postcode Stress Scale, and the Professional Quality of Life Scale: Compassion Fatigue subscale. RESULTS Nurses had moderate to high postcode stress and compassion fatigue (67.98 ± 16.39 and 65.40±14.34, respectively). Moreover, there was a significant positive correlation between postcode stress, burnout (r=0.350, p=<0.001), secondary traumatic stress (r=0.518, p=<0.001), and subsequently, compassion fatigue (r=0.449, p=<0.001). In addition, higher levels of postcode stress were associated with higher levels of compassion fatigue with its subscales: burnout and secondary traumatic stress, with a coefficient of determination for compassion fatigue (0.199), burnout subscale (0.121), and secondary traumatic stress (0.266). CONCLUSION Critical care nurses involved in resuscitation experiences are susceptible to postcode stress, burnout, secondary traumatic stress, and compassion fatigue. There is a significant relationship between these factors, with higher levels of postcode stress contributing to higher levels of compassion fatigue and its subscales: burnout and secondary traumatic stress. These results highlight the importance of addressing and managing the psychological well-being of nurses in resuscitation settings to mitigate the adverse effects of stress and promote their overall resilience and well-being.
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Affiliation(s)
- Ayman Mohamed El-Ashry
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt.
| | - Shimmaa Mohamed Elsayed
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Damanhour University, Damanhour, Egypt
| | - Mohamed Adel Ghoneam
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Beni-Suef University, Beni-Suef, Egypt
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Presciutti AM, Bannon SM, Yamin JB, Newman MM, Parker RA, Elmer J, Wu O, Donnino MW, Perman SM, Vranceanu AM. The relationship between mindfulness and enduring somatic threat severity in long-term cardiac arrest survivors. J Behav Med 2023; 46:890-896. [PMID: 36892781 PMCID: PMC9995732 DOI: 10.1007/s10865-023-00405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Cardiac arrest (CA) survivors experience continuous exposures to potential traumas though chronic cognitive, physical and emotional sequelae and enduring somatic threats (ESTs) (i.e., recurring somatic traumatic reminders of the event). Sources of ESTs can include the daily sensation of an implantable cardioverter defibrillator (ICD), ICD-delivered shocks, pain from rescue compressions, fatigue, weakness, and changes in physical function. Mindfulness, defined as non-judgmental present-moment awareness, is a teachable skill that might help CA survivors cope with ESTs. Here we describe the severity of ESTs in a sample of long-term CA survivors and explore the cross-sectional relationship between mindfulness and severity of ESTs. METHODS We analyzed survey data of long-term CA survivors who were members of the Sudden Cardiac Arrest Foundation (collected 10-11/2020). We assessed ESTs using 4 cardiac threat items from the Anxiety Sensitivity Index-revised (items range from 0 "very little" to 4 "very much") which we summed to create a score reflecting total EST burden (range 0-16). We assessed mindfulness using the Cognitive and Affective Mindfulness Scale-Revised. First, we summarized the distribution of EST scores. Second, we used linear regression to describe the relationship between mindfulness and EST severity adjusting for age, gender, time since arrest, COVID-19-related stress, and loss of income due to COVID. RESULTS We included 145 CA survivors (mean age: 51 years, 52% male, 93.8% white, mean time since arrest: 6 years, 24.1% scored in the upper quarter of EST severity). Greater mindfulness (β: -30, p = 0.002), older age (β: -0.30, p = 0.01) and longer time since CA (β: -0.23, p = 0.005) were associated with lower EST severity. Male sex was also associated with greater EST severity (β: 0.21, p = 0.009). CONCLUSION ESTs are common among CA survivors. Mindfulness may be a protective skill that CA survivors use to cope with ESTs. Future psychosocial interventions for the CA population should consider using mindfulness as a core skill to reduce ESTs.
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Affiliation(s)
- Alexander M Presciutti
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States.
- Harvard Medical School, Department of Psychiatry, Boston, United States.
| | - Sarah M Bannon
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States
- Harvard Medical School, Department of Psychiatry, Boston, United States
| | - Jolin B Yamin
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Emergency Medicine, Center for Resuscitation Science, Boston, United States
| | - Mary M Newman
- Sudden Cardiac Arrest Foundation, Wexford, United States
| | - Robert A Parker
- Harvard Medical School, Department of Medicine, Boston, United States
- Massachusetts General Hospital, Department of Medicine, Biostatistics Center, Boston, United States
| | - Jonathan Elmer
- Departments of Emergency Medicine, Critical Care Medicine, and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Ona Wu
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Boston, United States
- Harvard Medical School, Department of Radiology, Boston, United States
| | - Michael W Donnino
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Emergency Medicine, Center for Resuscitation Science, Boston, United States
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, United States
| | - Ana-Maria Vranceanu
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States
- Harvard Medical School, Department of Psychiatry, Boston, United States
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Aregger Lundh S, Israelsson J, Hagell P, Lilja Andersson P, Årestedt K. Life satisfaction in cardiac arrest survivors: A nationwide Swedish registry study. Resusc Plus 2023; 15:100451. [PMID: 37662640 PMCID: PMC10470084 DOI: 10.1016/j.resplu.2023.100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Most cardiac arrest (CA) survivors report good health and quality of life. Life satisfaction on the other hand has not yet been studied in a large scale in the CA population. We aimed to explore life satisfaction as perceived by CA survivors with three research questions addressed: (1) how do CA survivors report their life satisfaction, (2) how are different domains of life satisfaction associated with overall life satisfaction, and (3) how are demographic and medical factors associated with overall life satisfaction? Methods This registry study had a cross-sectional design. Life satisfaction was assessed using the 11-item Life Satisfaction checklist (LiSat-11). The sample included 1435 survivors ≥18 years of age. Descriptive statistics and binary logistic regression analyses were used. Results Survivors were most satisfied with partner relation (85.6%), family life (82.2%), and self-care (77.8%), while 60.5% were satisfied with overall life. Satisfaction with psychological health was strongest associated with overall life satisfaction. Among medical and demographic factors, female sex and poor cerebral performance were associated with less overall life satisfaction. Conclusions Generally, CA survivors seem to perceive similar levels of overall life satisfaction as general populations, while survivors tend to be significantly less satisfied with their sexual life. Satisfaction with psychological health is of special interest to identify and treat. Additionally, female survivors and survivors with poor neurological outcome are at risk for poorer overall life satisfaction and need special attention by healthcare professionals.
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Affiliation(s)
- Stefan Aregger Lundh
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Johan Israelsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Internal Medicine, Division of Cardiology, Region Kalmar County, Kalmar, Sweden
| | - Peter Hagell
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Petra Lilja Andersson
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
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Rojas DA, DeForge CE, Abukhadra SL, Farrell L, George M, Agarwal S. Family experiences and health outcomes following a loved ones' hospital discharge or death after cardiac arrest: A scoping review. Resusc Plus 2023; 14:100370. [PMID: 36909925 PMCID: PMC9999209 DOI: 10.1016/j.resplu.2023.100370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
Aim Synthesise the existing literature on experiences and health outcomes of family members of adult cardiac arrest patients either after hospital discharge or death and identify gaps and targets for future research. Methods Following recommended scoping review guidelines and reporting framework, we developed an a priori protocol and searched five large biomedical databases for all relevant studies published in peer-reviewed journals in the English language through 8/8/2022. Studies reporting either on the experiences or health outcomes of family members of adult cardiac arrest patients who survived to hospital discharge (i.e., co-survivors) or bereaved family members were included. Study characteristics were extracted and findings were reviewed for co-survivors and bereaved family members. We summarised practice recommendations and evidence gaps as reported by the studies. Results Of 44 articles representing 3,598 family members across 15 countries and 5 continents, 89% (n = 39) were observational. Co-survivors described caregiving challenges and difficulty transitioning to life at home after hospital discharge. Co-survivors as well as bereaved family members reported significant and persistent psychological burden. Enhanced communication, information on what to expect after hospital discharge or the death of their loved ones, and emotional support were among the top recommendations to improve family members' experiences and health outcomes. Conclusion Family members develop significant emotional burdens and physical symptoms as they deal with their loved ones' critical illnesses and uncertain, unpredictable recovery. Interventions designed to reduce family members' psychological distress and uncertainty prevalent throughout the illness trajectory of their loved ones admitted with cardiac arrest are needed.
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Affiliation(s)
- Danielle A. Rojas
- Department of Neurology, Division of Critical & Hospitalist Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Lia Farrell
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | - Sachin Agarwal
- Department of Neurology, Division of Critical & Hospitalist Neurology, Columbia University Irving Medical Center, New York, NY, USA
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10
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Presciutti AM, Flickinger KL, Coppler PJ, Ratay C, Doshi AA, Perman SM, Vranceanu AM, Elmer J. Protective positive psychology factors and emotional distress after cardiac arrest. Resuscitation 2023:109846. [PMID: 37207872 DOI: 10.1016/j.resuscitation.2023.109846] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND There is a critical need to identify factors that can prevent emotional distress post-cardiac arrest (CA). CA survivors have previously described benefitting from utilizing positive psychology constructs (mindfulness, existential well-being, resilient coping, social support) to cope with distress. Here, we explored associations between positive psychology factors and emotional distress post-CA. METHODS We recruited CA survivors treated from 4/2021-9/2022 at a single academic medical center. We assessed positive psychology factors (mindfulness [Cognitive and Affective Mindfulness Scale-Revised], existential well-being [Meaning in Life Questionnaire Presence of Meaning subscale], resilient coping [Brief Resilient Coping Scale], perceived social support [ENRICHD Social Support Inventory]) and emotional distress (posttraumatic stress [Posttraumatic Stress Checklist-5], anxiety and depression symptoms [PROMIS Emotional Distress - Anxiety and Depression Short Forms 4a]) just before discharge from the index hospitalization. We selected covariates for inclusion in our multivariable models based on an association with any emotional distress factor (p < 0.10). For our final, multivariable regression models, we individually tested the independent association of each positive psychology factor and emotional distress factor. RESULTS We included 110 survivors (mean age 59 years, 64% male, 88% non-Hispanic White, 48% low income); 36.4% of survivors scored above the cut-off for at least one measure of emotional distress. In separate adjusted models, each positive psychology factor was independently associated with emotional distress (β: -0.20 to -0.42, all p < 0.05). CONCLUSIONS Higher levels of mindfulness, existential well-being, resilient coping, and perceived social support were each associated with less emotional distress. Future intervention development studies should consider these factors as potential treatment targets.
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Affiliation(s)
- Alexander M Presciutti
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital; Department of Psychiatry, Harvard Medical School.
| | | | - Patrick J Coppler
- Department of Emergency Medicine, University of Pittsburgh School of Medicine
| | - Cecelia Ratay
- Department of Emergency Medicine, University of Pittsburgh School of Medicine
| | - Ankur A Doshi
- Department of Emergency Medicine, University of Pittsburgh School of Medicine
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital; Department of Psychiatry, Harvard Medical School
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine; Department of Critical Care Medicine, University of Pittsburgh School of Medicine; Department of Neurology, University of Pittsburgh School of Medicine
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11
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Princip M, Ledermann K, von Känel R. Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease. Curr Cardiol Rep 2023; 25:455-465. [PMID: 37129760 DOI: 10.1007/s11886-023-01870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE OF REVIEW To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. RECENT FINDINGS A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions.
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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12
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Chen X, Li D, He L, Yang W, Dai M, Lan L, Diao D, Zou L, Yao P, Cao Y. The prevalence of anxiety and depression in cardiac arrest survivors: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 83:8-19. [PMID: 37028095 DOI: 10.1016/j.genhosppsych.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE This systematic review aimed to identify the prevalence of anxiety and depression in cardiac arrest (CA) survivors. METHODS A systematic review and network meta-analysis was performed on observational studies in adult cardiac arrest survivors with psychiatric disorders from PubMed, Embase, Cochrane Library and Web of Science. In the meta-analysis, we combined the prevalence quantitatively and analyzed the subgroup based on the classification indexes. RESULTS We identified 32 articles that met the inclusion criteria. Regarding anxiety,the pooled prevalence was 24% (95% CI, 17-31%) and 22% (95% CI, 13-26%) in short-term and long-term respectively. The subgroup analysis showed that the pooled incidence in in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrests (OHCA) survivors was 14.0% (95%CI, 9.0-20.0%) and 28.0% (95%CI, 20.0-36.0%) for short-term anxiety.The incidence of anxiety measured by, Hamilton Anxiety Rating Scale(HAM-A) and State-Trait Anxiety Inventory(STAI) was higher than other tools(P < 0.01). Regarding depression,the data analysis showed that the pooled incidence of short-term and long-term depression was 19% (95% CI, 13-26%) and 19% (95% CI, 16-25%), respectively. The subgroup analysis showed that the incidence of short-term and long-term depression was 8% (95% CI, 1-19%) and 30% (95% CI, 5-64%) for IHCA survivors, and was 18% (95% CI, 11-26%) and 17% (95% CI, 11-25%) for OHCA survivors. The incidence of depression measured by Hamilton Depression Rating Scale(HDRS) and Symptom check list-90(SCL-90) was higher than other assessment tools(P < 0.01). CONCLUSIONS The meta-analysis indicated a high prevalence of anxiety and depression in CA survivors, and those symptoms persisted 1 year or more after CA. Evaluation tool is an important factor affecting the measurement results.
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Affiliation(s)
- Xiaoli Chen
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Lin He
- The Intelligence Library Center, Ministry of Science and Technology, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjie Yang
- Center of Biostatistics, Design, Measurement and Evaluation (CBDME), West China Hospital, Sichuan University, Chengdu, China
| | - Min Dai
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Lin Lan
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Dongmei Diao
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Liqun Zou
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Peng Yao
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yu Cao
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China.
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13
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Agarwal S, Birk JL, Abukhadra SL, Rojas DA, Cornelius TM, Bergman M, Chang BP, Edmondson DE, Kronish IM. Psychological Distress After Sudden Cardiac Arrest and Its Impact on Recovery. Curr Cardiol Rep 2022; 24:1351-1360. [PMID: 35921024 PMCID: PMC9561080 DOI: 10.1007/s11886-022-01747-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the prevalence, correlates, and health consequences of poor mental health in the increasingly sizable population of survivors of Sudden cardiac arrest (CA) and to describe current intervention research in this area. RECENT FINDINGS After CA many patients report high psychological distress, including depression, generalized anxiety, and posttraumatic stress. Emerging evidence suggests that distressed patients' attention may narrow such that anxious awareness of afferent cardiac signals e.g., changes in heart rate or blood pressure, becomes predominant and a cause for concerned, constant monitoring. This cardiac-specific anxiety followed by behavioral avoidance and physiological hyperreactivity may increase patients' already high risk of secondary cardiovascular disease and undermine their health-related quality of life (HRQoL). Unlike other cardiovascular diseases, no clinical practice guidelines exist for assessing or treating psychological sequelae of CA. Future research should identify modifiable psychological targets to reduce secondary cardiovascular disease risk and improve HRQoL.
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Affiliation(s)
- Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA.
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Sabine L Abukhadra
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA
| | - Danielle A Rojas
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA
| | - Talea M Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Maja Bergman
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, USA
| | - Donald E Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
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14
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Presciutti A, Siry‐Bove B, Newman MM, Elmer J, Grigsby J, Masters KS, Shaffer JA, Vranceanu A, Perman SM. Qualitative Study of Long‐Term Cardiac Arrest Survivors’ Challenges and Recommendations for Improving Survivorship. J Am Heart Assoc 2022; 11:e025713. [PMID: 35861822 PMCID: PMC9707841 DOI: 10.1161/jaha.121.025713] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Cardiac arrest survivorship refers to the lived experience of long‐term survivors of cardiac arrest and the many postdischarge challenges they experience. We aimed to gather a nuanced understanding of these challenges and of survivors' perceptions of ways to improve the recovery process.
Methods and Results
We conducted 15 semistructured, one‐on‐one interviews with cardiac arrest survivor members of the Sudden Cardiac Arrest Foundation; the interviews were conducted by telephone and recorded and transcribed verbatim. We used thematic analysis, informed by the Framework Method, to identify underlying themes regarding cardiac arrest survivorship challenges and recommendations to improve cardiac arrest survivorship. Regarding challenges, the overarching theme was a feeling of unpreparedness to confront postarrest challenges because of lack of resources, education, and appropriate expectations for recovery. Regarding recommendations, we uncovered 3 overarching themes including systemic recommendations (eg, providing appropriate resources and expectations, educating providers about survivorship, following up with survivors, including caregivers in treatment planning), social recommendations (eg, attending peer support groups, spending time with loved ones, providing support resources for family members), and individual coping recommendations (eg, acceptance, resilience, regaining control, seeking treatment, focusing on meaning and purpose).
Conclusions
We described common challenges that survivors of cardiac arrest face, such as lacking resources, education, and appropriate expectations for recovery. Additionally, we identified promising pathways that may improve cardiac arrest survivorship at systemic, social, and individual coping levels. Future studies could use our findings as targets for interventions to support and improve survivorship.
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Affiliation(s)
- Alex Presciutti
- Department of Psychology University of Colorado Denver Denver CO
- Department of Psychiatry Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital Boston MA
- Department of Psychiatry Harvard Medical School Boston MA
| | - Bonnie Siry‐Bove
- Department of Emergency Medicine University of Colorado School of Medicine Denver CO
| | | | - Jonathan Elmer
- University of Pittsburgh School of Medicine, Departments of Emergency Medicine, Critical Care Medicine and Neurology Pittsburgh PA
| | - Jim Grigsby
- Department of Psychology University of Colorado Denver Denver CO
| | - Kevin S. Masters
- Department of Psychology University of Colorado Denver Denver CO
| | | | - Ana‐Maria Vranceanu
- Department of Psychiatry Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital Boston MA
- Department of Psychiatry Harvard Medical School Boston MA
| | - Sarah M. Perman
- Department of Emergency Medicine University of Colorado School of Medicine Denver CO
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15
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Mindfulness is inversely associated with psychological symptoms in long-term cardiac arrest survivors. J Behav Med 2022; 45:643-648. [PMID: 35157171 PMCID: PMC8853140 DOI: 10.1007/s10865-022-00295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022]
Abstract
Identifying correlates of psychological symptoms in cardiac arrest (CA) survivors is a major research priority. In this longitudinal survey study, we evaluated associations between mindfulness, baseline psychological symptoms, and 1-year psychological symptoms in long-term CA survivors. We collected demographic and CA characteristics at baseline. At both timepoints, we assessed posttraumatic stress symptoms (PTS) through the PTSD Checklist-5 (PCL-5) and depression and anxiety symptoms through the Patient Health Questionnaire-4 (PHQ-4). At follow-up, we assessed mindfulness through the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). We used adjusted linear regression to predict 1-year PCL-5 and PHQ-4 scores, with particular consideration of the CAMS-R as a cross-sectional correlate of outcome. We included 129 CA survivors (mean age: 52 years, 52% male, 98% white). At 1-year follow-up, in adjusted models, CAMS-R (β: −0.35, p < 0.001) and baseline PCL-5 scores (β: 0.56, p < 0.001) were associated with 1-year PCL-5 scores. CAMS-R (β: −0.34, p < 0.001) and baseline PHQ-4 scores were associated with 1-year PHQ-4 scores (β: 0.37, p < 0.001). In conclusion, mindfulness was inversely associated with psychological symptoms in long-term CA survivors. Future studies should examine the longitudinal relationship of mindfulness and psychological symptoms after CA.
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16
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Dainty K, Seaton M, Cowan K, Laupacis A, Dorian P, Douma M, Garner J, Goldstein J, Shire D, Sinclair D, Thurlow C, Vaillancourt C. Partnering with survivors & families to determine research priorities for adult out-of-hospital cardiac arrest: A James Lind Alliance Priority Setting Partnership. Resusc Plus 2021; 7:100148. [PMID: 34286310 PMCID: PMC8274337 DOI: 10.1016/j.resplu.2021.100148] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Research priority setting in health care has historically been done by expert health care providers and researchers and has not involved patients, family or the public. Survivors & family members have been particularly absent from this process in the field of resuscitation research and specifically adult out of hospital cardiac arrest (OHCA). As such, we sought to conduct a priority setting exercise in partnership with survivors, lay responders and their families in order to ensure that their priorities were visible. We partnered with the James Lind Alliance (UK) and used their commonly used consensus methodology for Public Priority Setting Partnerships (PSPs) to identify research priorities that reflected the perspectives of all stakeholders. METHODS We used two rounds of public and health care professional surveys to create the initial priority lists. The initial survey collected open-ended questions while the second round consolidated the list of initial questions into a refined list for prioritization. This was done by reviewing existing evidence and thematic categorization by the multi-disciplinary steering committee. An in-person consensus workshop was conducted to come to consensus on the top ten priorities from all perspectives. The McMaster PPEET tool was used to measure engagement. RESULTS The initial survey yielded more than 425 responses and 1450 "questions" from survivors and family members (18%), lay responders, health care providers and others. The second survey asked participants to rank a short list of 125 questions. The final top 25 questions were brought to the in-person meeting, and a top ten were selected through the JLA consensus process. The final list of top ten questions included how to improve the rate of lay responder CPR, what interventions used at the scene of an arrest can improve resuscitation and survival, how survival can be improved in rural areas of Canada, what resuscitation medications are most effective, what care patient's family members need, what post-discharge support is needed for survivors, how communication should work for everyone involved with a cardiac arrest, what factors best predict neurologically intact survival, whether biomarkers/genetic tests are effective in predicting OHCA and more research on the short and long-term psycho-social impacts of OHCA on survivors. The PPEET showed overwhelmingly positive results for the patient and family engagement experience during the final workshop. CONCLUSIONS This inclusive research priority setting provides essential information for those doing resuscitation research internationally. The results provide a guide for priority areas of research and should drive our community to focus on questions that matter to survivors and their families in our work. In particular the Canadian Resuscitation Outcomes Consortium will be incorporating the top ten list into its strategic plan for the future.
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Affiliation(s)
- K.N. Dainty
- North York General Hospital and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - M.B. Seaton
- North York General Hospital, Toronto, Ontario, Canada
| | | | - A. Laupacis
- Li Ka Shing Knowledge Institute and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - P. Dorian
- Unity Health Toronto and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M. Douma
- University of Dublin, Dublin, Ireland
| | - J. Garner
- Family member, Toronto, Ontario, Canada
| | - J. Goldstein
- Dalhousie Emergency Health Service, Halifax, Nova Scotia, Canada
| | - D. Shire
- Survivor, Toronto, Ontario, Canada
| | - D. Sinclair
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - C. Thurlow
- Survivor, Vancouver, British Columbia, Canada
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17
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Presciutti A, Newman MM, Sawyer KN, Agarwal S, Perman SM. Gaps in the Provision of Cognitive and Psychological Resources in Cardiac Arrest Survivors with Good Neurologic Recovery. Ther Hypothermia Temp Manag 2021; 12:61-67. [PMID: 33978474 DOI: 10.1089/ther.2021.0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We aimed to elucidate gaps in the provision of cognitive and psychological resources in cardiac arrest survivors. We conducted an online survey study between October 29, 2019, and November 15, 2019 with cardiac arrest survivors and caregiver members of the Sudden Cardiac Arrest Foundation. We queried survivors as to whether they experienced cognitive or psychological symptoms since their cardiac arrest. Next, we queried both survivors and caregivers on the provision of resources through three metrics: (1) discussions with providers about potential cognitive or psychological symptoms, (2) neurologist or psychologist appointments scheduled by providers, and (3) mental health referrals by providers. We then ran Chi-square goodness-of-fit tests to compare the proportion of survivors and caregivers who reported resource provision (observed values) to the proportion of survivors who reported experiencing cognitive and psychological symptoms, respectively (expected values). We included responses from 167 survivors and 52 caregivers. A total of 73.1% (n = 122) survivors reported experiencing cognitive symptoms and 67.1% (n = 112) psychological symptoms since their cardiac arrest. When compared to these two proportions, provision of resources was significantly lower in all three metrics: (1) fewer discussions with providers about potential for developing cognitive symptoms (31%) and psychological symptoms (26.3%), (2) fewer neurologist appointments scheduled (8.4%) and psychologist appointments scheduled (4.8%), and (3) fewer referrals to mental health (6%). Informal caregivers also reported significantly lower provision of resources in all three metrics, with the exception of discussions about developing cognitive symptoms. Our results suggest that there are discrepancies in the provision of cognitive and psychological resources in cardiac arrest survivors with good neurologic recovery. Systematic referral processes may be needed to standardize resource provision to consistently meet the pervasive cognitive and psychological needs of cardiac arrest survivors.
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Affiliation(s)
- Alex Presciutti
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mary M Newman
- Sudden Cardiac Arrest Foundation, Pittsburgh, Pennsylvania, USA
| | - Kelly N Sawyer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sachin Agarwal
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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