No abstract

Introduction: The growing Hispanic community faces disproportionate hardship due to lower financial capital and educational opportunity. The Hispanic health paradox refers to the finding that Hispanics tend to have better cardiovascular outcomes than non-Hispanics, despite facing greater hardships and more cardiovascular risk factors. Behavioral (e.g., sleep) and psychological (e.g., optimism) factors predict recovery after acute coronary syndrome events, but less is known about how these factors differ by ethnicity after cardiac arrest (CA). We tested demographic, psychological, behavioral, and recovery factors that may underlie the Hispanic health paradox among CA survivors. Hypothesis: We hypothesized that Hispanic vs. non-Hispanic cardiac arrest survivors would have lower income and education but would not differ in behavioral, psychological, and recovery factors. Methods: An observational cohort study, Psychological predictors of recovery after an Acute Cardiac Event (PACE) , enrolled 68 neurologically intact CA survivors admitted to NewYork-Presbyterian Hospital. At hospital discharge, self-reported demographic, psychological, behavioral, and recovery variables were assessed. Independent-samples t-tests of Hispanic vs. non-Hispanic CA survivors were conducted comparing income, education, posttraumatic stress symptoms, depression, negative affect, cardiac anxiety, optimism, positive affect, social support, sleep, physical activity, independent activities of daily living, and self-maintenance. Results: As hypothesized, Hispanic vs. non-Hispanic participants had lower income, Mann Whitney U = 99.00, z = -3.46, p < .01, and lower education, Mann Whitney U = 336.00, z = -2.65, p = .01. Unexpectedly, Hispanic patients reported greater cardiac anxiety M = 39.60, SD = 16.70) than non-Hispanic patients ( M = 30.29, SD = 11.67), t (66) = -2.722, p = .008. No other tested factors were significant, all p s ≥ .419. Conclusions: Cardiac anxiety is the only tested variable that differed by ethnicity. While Hispanic ethnicity may be protective for certain aspects of cardiovascular health, the present findings indicate that Hispanic CA survivors experience higher psychological distress, which itself is a known risk factor for poor health behaviors. Future research should assess potential drivers of cardiac anxiety (e.g., mistrust of healthcare system, poor patient-physician communication). Future intervention research should target heart-related fear during CA recovery.

Objective: To estimate the prospective association of cardiac anxiety at cardiac arrest (CA) discharge with subsequent risk for cardiovascular disease (CVD)/mortality after adjusting for general psychological distress and test its independent association with health-related quality of life (HRQoL). Our second objective is to test whether cardiac anxiety after CA is associated with low physical activity (PA) and/or short sleep shortly after discharge. Our third objective will test if low PA and/or short sleep mediate the association between cardiac anxiety and 12-month CVD/mortality post-discharge for CA. Further, the study will test the associations of general psychological distress with cardiac vagal control assessed by activity-adjusted heart rate variability. Background: Survivorship after CA is on the rise. However, survivors remain at markedly elevated risk for CVD, and many report poor HRQoL in the year after CA. Cardiac anxiety (i.e., cardiac specific-fear, avoidance behavior, and excessive cardiac symptom monitoring) has been shown in non-CA CVD patients to be associated with higher rates of psychological distress, avoidance of PA and poor sleep, patient-reported disability, and poor perceived health. Further, despite the association of low PA and poor sleep in CVD risk, no study has assessed those health behaviors in CA survivors. Design/Methods: This observational cohort study (anticipated n = 246) will evaluate CVD prognosis, HRQoL in the first year of survivorship of neurologically intact CA survivors admitted to New York Presbyterian Hospital between May 2021 and April 2026. At hospital discharge, 1, 6, and 12 months, study participants will be assessed for cardiac anxiety, and general psychological distress (screening measures for depression, posttraumatic stress, generalized anxiety symptoms), positive psychological factors (optimism, positive affect, purpose in life), functional (modified Rankin Scale) and telephone-based cognitive assessments. For 1-week post-discharge, and 1 week at 6-months post-discharge we will assess the level of PA and sleep duration using wrist-worn actigraphy, daily psychological factors using mobile ecological momentary assessment, and heart rate/heart rate variability using chest-worn patches. Results: Of the 21 patients enrolled to date (mean age 57 years, 10 women). The presentation will describe patterns of physical activity, sleep, both negative and positive psychological factors at 1-month post-discharge relative to discharge status. Conclusions: This is the first major prospective cohort study of CA survivorship, and the first to objectively assess health behaviors. By identifying malleable intervention targets for improving both CVD/mortality risk and post-CA HRQoL, this study could ignite the development of the first generation of CA survivorship interventions.