CardiovascularThe impact of psychological distress on long-term recovery perceptions in survivors of cardiac arrest
Introduction
Innovations in technology and treatment protocols have led to improvements in survival rates after cardiac arrest [1]. With the advent of greater survivability, there has been increased recognition of post-cardiac arrest survivorship as a chronic condition implicated in cognitive, functional, and psychological sequelae secondary to anoxic brain injury [[2], [3], [4]]. Given the overall increase in patients with multiple chronic conditions, value based health care systems [5] have prioritized outcomes deemed important by the patient (i.e. patient reported outcome measures (PROMs)), which can help facilitate shared decision making. Utilization of PROMs has led to improvements in patients' daily lives, such as satisfaction with care [6] and depressive symptoms [7]. Accordingly, identifying underlying factors contributing to an encompassing PROM, such as perceived recovery, could improve the daily and multifaceted challenges faced by cardiac arrest survivors.
Despite the various chronic symptoms that cardiac arrest survivors face, it remains unclear which deficits are most strongly associated with long-term perceived recovery. For example, Steinbusch et al. [8] found that post-arrest patients' perceived cognitive impairments were not indicative of their actual cognitive impairments at 3- and 12-month follow-ups. On the contrary, Juan et al. [9] found post-arrest patients' cognitive impairments, but not depressive symptoms, to be strongly correlated with negative perceptions of recovery at 6-months; however, the incidence of depression in that cohort was low (6%), and the relatively small sample size (n = 50) precluded definitive conclusions. In samples of stroke survivors and older adults, subjects' cognitive complaints were correlated with emotional well-being and depressive symptoms, rather than objective measures of cognitive impairment [10,11].
There is strong support linking psychological sequelae with subjective well-being, and potentially perceived recovery, in patients with cardiac disease. For example, the prevalence of posttraumatic stress disorder (PTSD) secondary to a cardiac event has ranged from 0 to 38% (averaging 12%) [12]. This condition has been linked to negative illness perceptions, emotional distress, reduced quality of life, and preoccupation with somatic symptoms [12]. Depressive symptoms also pose a challenge for cardiac patients; 20–40% meet criteria for major depressive disorder or experience an increase in chronic and persistent depressive symptoms post-diagnosis [13]. Further, in cardiac patients, depression has been found to be a stronger predictor of quality of life than measures of disease severity including cardiac function, ejection fraction, and ischemia [14].
We recently demonstrated that posttraumatic stress and depressive symptoms, not cognitive or functional impairment, were associated with cardiac arrest survivors' negative recovery perceptions at hospital discharge [15]. The present study aims to extend this work by examining the correlates of perceived recovery in these cardiac arrest survivors at 6 months after their hospital discharge. This is especially important to delineate in order to identify possible modifiable factors for improving perceived recovery, as is vital in value based health care systems. Based on the strong link between cardiac disease-induced psychological symptoms and outcomes of subjective well-being, we tested the hypothesis that depressive and PTSD symptoms are correlated with cardiac arrest survivors' long-term recovery perceptions even after accounting for cognitive status, functional independence, and medical comorbidities. In addition, we examined the stability of recovery perceptions from discharge to 6 months.
Section snippets
Screening procedure and patient enrollment
Details on the patient screening and enrollment procedure at hospital discharge can be found at Presciutti et al. [15]. Briefly, subjects were included if they were ≥ 18 years of age, resuscitated following either in-hospital or out-of-hospital cardiac arrest, admitted to Columbia University Medical Center, and survived to hospital discharge between September 2015 and September 2017.
As part of research protocol, daily intensive care unit screening identified potential participants per
Participant characteristics
Information on the overall sample enrollment can be seen in Fig. 1. No significant differences were found between those with a negative recovery perception from those with a positive recovery perception in terms of demographic characteristics (Table 1). Patients that were lost to follow-up had significantly shorter length of stays in both the intensive care unit (p < .05) and the hospital (p < .01) and were less likely to receive bystander CPR by nonmedical personnel (p < .05) compared to those
Discussion
This cross-sectional analysis found that depressive symptoms, not cognitive impairment, functional dependence, or medical comorbidities, were associated with cardiac arrest survivors' recovery perceptions at long-term follow-up. Patients with greater depressive symptoms were more likely to have a negative recovery perception 6-months after hospital discharge from their cardiac arrest. Overall, 80% of patients that screened positive for probable depression and 73% of patients that screened
Conclusions
In contrast with cognitive and functional measures, depressive symptoms were strongly associated with cardiac arrest survivors' negative recovery perceptions. This study adds to the support that psychological symptoms are intimately tied to subjective recovery in patients with chronic cardiac conditions, and thus cannot be overlooked in the evaluation and management of such patients.
Conflicts of interest
The authors have no relevant conflicts of interest to report.
The following are the supplementary data related to this article.
Acknowledgements
We thank Dr. Angela Velazquez for her support with data collection. We also thank the nurses, physician assistants, nurse practitioners, and physicians who take care of these patients.
Financial disclosures
Dr. Sumner acknowledges support of a K01 award (K01HL130650). Dr. Park acknowledges support of a K01 award (K01ES026833). Dr. Kronish acknowledges support of an R01 award (R01HL132347).
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2022, Journal of Affective DisordersCitation Excerpt :Psychological distress is common in the general population, ranging 5–27% (Benzeval and Judge, 2001; Chittleborough et al., 2011; Gispert et al., 2003; Kuriyama et al., 2009; Phongsavan et al., 2006), and can be as high as 60% in some hospital populations (Ayana et al., 2019). Unfortunately, psychological distress is poorly recognized or managed at the primary care level despite its negative impact on patients’ health outcomes, including lowering adherence to treatment (Mutumba et al., 2016), prolonging recovery from physical illness (Presciutti et al., 2019), and even leading to suicidal behaviors (Tang et al., 2018). Screening, assessment, and intervention to reduce patients’ psychological distress may improve their overall health outcomes (Haverkamp et al., 2015; Krebber et al., 2016; Lee et al., 2010).