Introduction: Cardiac arrest (CA) survivors have significant impairments and poor functional outcomes at hospital discharge. We assessed if discharge disposition to acute inpatient rehabilitation after CA-related hospitalization is associated with improved functional recovery at 12 months relative to alternative acute care hospital discharge dispositions. Methods: Adults with the return of spontaneous circulation after in-hospital or out-of-hospital CA between 2/1/2016- 1/31/2020 admitted to intensive care units in a single tertiary care center were enrolled in an observational, prospective cohort study. A series of logistic regressions were used to assess acute inpatient rehabilitation associations with good functional recovery patterns, defined as persistent Modified Rankin Score (mRS) 0-2, or absence of any worsening of mRS at 12 months relative to discharge mRS. The model included demographics, individual and structural-level Social Determinants of Health, and pertinent clinical characteristics. Results: Of 201 included patients (24% Hispanic and 19% Black; average age 56±16 years; 40% women), 63% (n=127) reported good functional recovery pattern. Patients who went to acute inpatient rehabilitation were significantly more likely to experience good recovery pattern (54.3% vs 37.8% with poor recovery pattern, p<0.01). In a multivariable model, acute inpatient rehabilitation was significantly associated with a good recovery pattern when compared to other discharge dispositions (home with out-patient rehabilitation services (odds ratio (OR), 0.3; CI, 0.1-0.8; p = 0.02), and skilled nursing facility (OR, 0.2; CI, 0.1-0.6; p<0.01). SDOH including minority race/ethnicity, poor insurance, premorbid unemployment, no carepartner or spouse, and patients with longer hospital length of stay had independent and significant associations with poor functional recovery patterns. Conclusions: Acute inpatient rehabilitation was associated with a good functional recovery pattern 12 months after hospital discharge from CA. Social determinants of health have an independent effect on the functional recovery patterns and should be systematically collected for future outcome-based studies.

Introduction: Cardiac arrest (CA) patients’ fear of contracting Coronavirus disease 2019 (COVID-19) may limit their ability or willingness to perform cardio-protective health behaviors. We assessed the association of COVID-19 anxiety with physical activity (PA), sleep, and the likelihood of seeking medical care. Methods: Between May 15-28, 2020, a month after the NYC COVID-19 pandemic peak, CA survivors from a prospective cohort were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and behavioral dimensions. COVID-19 anxiety was assessed using the 7-item Perceived Coronavirus Threat Questionnaire (PCTQ; range 1-42). PA in 7 days both pre- and during COVID-19 was categorized into International Physical Activity Questionnaire-based low, moderate, or high activity levels. Self-reported poor sleep quality and hours of sleep per night in the previous month were assessed via the Pittsburgh Sleep Quality Index. Self-reported likelihood of delay in seeking care for non-COVID related conditions was assessed. Results: Of 100 approached, 75 CA survivors participated (53% male; age 61±15 years; 44% White, 20% Black, and 31% Latinx). The majority (84%) were COVID-19 tests and/or symptoms negative. The median COVID-19 anxiety score was 28 (interquartile range [IQR]: 21-37)- indicating substantial fear. Black and Latinx participants reported greater COVID-19 anxiety than White (33±6 vs 32±8 vs 23±10 respectively, p=0.03). Compared to pre-COVID, CA survivors had reduced their days per week engagement in any PA by an average of 2±3.6 days. COVID-19 anxiety was highest in those who were previously high PA and now were low PA (high-high:25±9, low-low:28±9, and high-low:32±4, ANOVA p=0.06). For every 1 SD increase in COVID-19 anxiety, participants reported 45 min less sleep per night (B= -0.05, p =.06) and poorer sleep quality (OR = 1.07, 95% CI [1.0, 1.1], p=0.017). Participants (48%) who said they were “moderately” to “extremely” likely to delay seeking care for non-COVID related conditions had greater levels of COVID-19 anxiety (32±9 vs 26±10, p=0.02) compared to other responses. Conclusions: COVID-19 anxiety is more frequent in Black and Latinx participants and is associated with poorer health behaviors.

Introduction: In light of the COVID-19 pandemic, various emergency medical services (EMS) and health agencies in New York City (NYC), and other hard-hit cities, issued new guidelines terminating resuscitation efforts in cases of out of hospital cardiac arrests (CA). This guidance was issued to protect the health and safety of EMS providers, to conserve hospital resources, and to ensure optimal use of equipment to save the greatest number of lives. However, the psychological impact of this public health messaging on existing CA survivors has not yet been studied. Methods: Between 5/15 - 5/18 of 2020, a month after the NYC COVID-19 pandemic peak, CA survivors from an ongoing, prospective study, were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and behavioral dimensions. COVID-19 anxiety was assessed using the 7-item Perceived Coronavirus Threat Questionnaire (PCTQ; e.g., “I am stressed around other people because I worry I’ll catch the coronavirus;” range 1-42). Survivors’ self-reported fear and uncertainty in receiving immediate life-saving care in the event of a CA due to recent public health messaging was assessed on a 5-point Likert-scale (Not at all—extremely). Results: Of 100 approached, 75 CA survivors participated (53% male; age 61±15 years; 44% non-Hispanic White, 20% Black, and 31% Latinx). The majority, 63 of 75 (84%), had no COVID-19 symptoms or had not been tested. The median COVID-19 anxiety score was 28 (interquartile range [IQR]: 21-37). Participants who were “very to extremely” afraid that emergency care would not come if they had another CA made up 45% (34 of 75; 95% C.I: 34-57) and scored 1 SD higher (mean±SD 34±6 vs 23±9, p<0.001) on COVID-19 anxiety scores than those with little fear about the availability of emergency care. The association was significant after adjusting for age, race, sex, and COVID-19 testing status (Odds Ratio = 1.17; 95% CI: [1.079, 1.274]; p<0.001). Conclusion: A better understanding of the potential psychological impact of disaster-related public health messaging is needed to prevent campaigns from causing additional distress and contributing to poor mental health and quality of life.