Introduction:
We have shown that cardiac arrest-induced psychological distress is associated with an increased risk of cardiovascular disease (CVD) events and death. Low physical activity (PA) is a known risk factor for recurrent CVD events. We hypothesize that aversive cognitions about PA due to fear of trauma-related bodily sensations may lead to poor engagement in PA after cardiac arrest (CA).
Methods:
We prospectively enrolled 58 adults with a return of spontaneous circulation after in-hospital or out-of-hospital CA between 9/2015-8/2018 at a high-volume, major academic center. We studied 58 patients who survived CA and were discharged from Columbia University. Aversive cognitions about PA were measured with the following items: 1) “I am anxious when I think about doing PA at home;” 2) “I worry that doing PA at home will trigger another cardiac event;” 3) “I fear that I won’t know what is and isn’t safe;” 4) “I worry that I will die.” Patients responded using a 4-point Likert scale and “extremely” or “moderately” responses were classified as having aversive cognitions for each item. Items were adapted from the Anxiety Sensitivity Index.
Results:
Of 58 patients included (50% women, 52% minorities, average age 55±17 years) greater than 2/3 of the respondents reported at least one of the concerns about PA both at discharge and 12 months after discharge. Many (62% at discharge and 65% at 12 months) are not engaged in recommended levels of physical activity. Patients who reported at least 1 concern were almost 4 times more likely to have NOT engaged in PA at home (vs those who reported no concerns) since the CA event (OR= 4 (1.3-14) P=0.01), after adjusting for age, sex, and time since the event. Fear of death was independently associated with low engagement after adjusting for age, sex, and time since the event (OR 1.9 (1-3.7) P=0.05). Of all 58 participants, 71% at discharge and 76% at 12 months reported feeling that any PA done at home without medical supervision was either “not safe at all” or “only somewhat safe.”
Conclusion:
Survivors of CA frequently experience PA-induced anxiety and avoid PA because of the fear of recurrence or death. PA avoidance as an underlying mechanism by which psychological distress worsens prognosis in CA patients should be tested prospectively.
Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home