[R01] Patterns of Survivors' Recovery Trajectories in the ICECAP Trial (POST-ICECAP)
Ente: National Institute of Neurological Disorders and Stroke
Scadenza: 2029-05-31
Importo max: 2.184.105 EUR
Paese: US
Descrizione
Project Summary: Many patients now survive out-of-hospital cardiac arrest (OHCA), however gaps in
knowledge about long-term outcomes result in a fragmented and underdeveloped continuum of care to achieve
recovery. Recovery is defined as significant improvement in functional and cognitive outcomes, and health-
related quality of life (HRQoL). OHCA Survivors with favorable recovery patterns may potentially go back to
work and/or social roles. Prior studies assessing recovery domains after OHCA are small, limited to single
centers, and short-term outcomes i.e., 1-3 months. Identifying individual patient patterns of recovery over
longer-term, and the ability to predict who will be likely to need more intensive support after discharge would
allow interventions to be targeted more efficiently. It is also crucial that we offer patients and their families the
best information available about a patient's prospects for continued recovery even in the absence of modifiable
intervention targets. This study will quantify recovery after out-of-hospital cardiac arrest (OHCA) using standardized, clinically meaningful outcome measures and identify modifiable clinical and care-delivery factors associated with preservation and restoration of recovery. We will derive empirically supported targets to inform and test interventions aimed at improving patient-centered outcomes.
Our single-center pilot study has found that nearly one-third of the OHCA survivors had clinically important
differences between long-term (12 months) and short-term (3 months) functional outcomes with large between-
individual variability in recovery (i.e., improvement or worsening). We found that inpatient acute rehabilitation was associated with improved 12-month functional recovery compared to other discharge dispositions. Differences in recovery outcomes across patient groups were observed; subsequent analyses will evaluate the extent to which these differences are explained by modifiable clinical, treatment, and access-to-care factors.
To fill this gap, we propose an ancillary study to the NINDS/NHLBI-funded ICECAP trial, conducted within the
60 sites of the NIH emergency care trials network, to describe recovery (functional outcome [primary],
Cognition, and HRQoL outcomes [secondary]) in a large, well-characterized, racially/ethnically diverse,
representative cohort of US OHCA patients. We will enroll n=1,000 who were screened for ICECAP and
survive to hospital discharge. The parent ICECAP trial includes a telephone follow-up visit at 1 month and an
in-person visit at 3 months. The ancillary study will add two telephone/videoconferencing visits at 6 and 9
months and an in-person visit at 12 months after OHCA.
For Aim 1, we will describe between-patient variability in recovery (i.e., improvement in functional, cognitive,
and HRQoL outcomes) from 3 to 12 months after OHCA, and test whether changes are associated with illness
severity scores, and critical care interventions performed during t
Istituzione: COLUMBIA UNIVERSITY HEALTH SCIENCES
PI: Sachin Agarwal, Clifton W. Callaway
Progetto: 5R01NS127959-03
Settori: National Institute of Neurological Disorders and Stroke
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