Trajectory Of Recovery Following Sudden Cardiac Arrest After An Initial Icd In A Social Cognitive Theory Intervention

Introduction: Sudden cardiac arrest (SCA) survivorship results in unique issues in return to physical & psychological functioning. The purpose of this study was to examine trajectories of recovery between SCA survivors & other patients who received an initial secondary prevention implantable cardioverter defibrillator (ICD) & participated in a social cognitive theory (SCT) intervention. Hypothesis: One-year recovery trajectories will differ for SCA survivors vs others who received an ICD for secondary prevention. Methods: 168 (129 men, 39 women) who received an ICD for secondary prevention [VF cardiac arrest (N=65), ICD other reason (N=103)] were randomized to a SCT intervention (N=85) or usual care (N=83). The SCT intervention consisted of 8 weeks of nurse led telephone coaching & self-management strategies to enhance recovery over 1 year. Outcomes measured at baseline hospital discharge, 1, 3, 6, & 12 months included: 1) Physical Function [Patient Concerns Assessment (PCA), SF-36 (PCS)]; 2) Psychological Adjustment [State Trait Anxiety Inventory (STAI), CES-D depression, SF-36 (MCS)]; & 3) Self-Efficacy [SCA Self-Efficacy (SCA-SE), Self-management behaviors (SMB), Outcome Expectations (OE)]. Outcome differences were compared over 12 months by intervention group (SCT vs UC) & by SCA vs. ICD-other groups, using general estimating equations (GEE), adjusting for baseline age, gender, & ethnicity. Results: Participants were Caucasian (89%), averaged 63.95±12.3 years, EF% 33.95±13.9, BMI 28.19±6.2, & Charlson Index 4.27±2.3. No significant demographic differences were noted between groups. Physical function (PCS) remained low & anxiety (STAI) high in all groups over time. Self-efficacy (SCA-SE) was lower in SCA survivors compared to others. Physical symptoms (PCA) decreased significantly (Wald X 2, 8.38, p=0.04) for SCA survivors vs. ICD-others over 1 year; Psychological Adjustment (MCS) was significantly lower in SCA survivors in the SCT intervention at 6 months & recovered at 12 months (Wald X 2 , 7.25, p=0.05); OEs were significantly lower for SCA survivors in the SCT intervention (Wald X 2 , 6.99, p=0.008). Conclusion: SCA survivors had fewer physical symptoms, lower levels of mental health & OE over 12 months, despite a SCT intervention.