Living Life to the Fullest After Cardiac Arrest
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This document discusses living life after surviving cardiac arrest. It begins with an overview of resiliency factors that can help cardiac survivors recover and adapt well, such as benefit finding, social support, and optimism. It then addresses common concerns after surviving cardiac arrest such as vulnerability, dependence on medical devices, and identity changes. The document provides coping strategies for cardiac survivors like continuing activities they enjoy, setting goals, and educating themselves. It emphasizes the importance of behavioral and emotional health for cardiovascular health and recovery.
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Living Life to the Fullest After Cardiac Arrest
- 1. Living and Loving Life: A.er Cardiac Arrest Eva R. Serber, Ph.D. Centers for Behavioral & Preven9ve Medicine, The Miriam Hospital Department of Psychiatry & Human Behavior, Warren Alpert Brown Medical School
- 2. Disclosures • Medtronic, Inc – Speaker Honoraria • NIH/NHLBI – R21 HL092340 (CARE-‐E Trial) Ψ © 2010 Serber
- 3. FULL par:cipa:on in a FULL life Ψ © 2010 Serber
- 4. Survivors living not simply living surviving Ψ © 2010 Serber
- 5. Today’s discussion: • Resiliency • Behavioral Health • Preven9on of poor adjustment • Emo9ons and cardiovascular disease • What to look for in yourself and loved ones • Ways to improve mood and return to life Ψ © 2010 Serber
- 6. The Ini:al Reac:on • Gra9tude • Surprised and confused – “Why me?” “How could this happen?” – Clean bill of health – Pinnacle of my [career, sport] – Peak fitness – Top of my game • Sense of loss – Func9oning/ac9vi9es – Independence • Anger / Sadness Ψ © 2010 Serber
- 7. Your sen:ments: “I thank God” “blessed” “live life” “empowerment” “appreciate rela9onships” “new life / second chance” “reinvent myself” “embracing life” “changed my outlook” “pay it forward” “return to [life]” “gra9tude” “advocate for change” Ψ © 2010 Serber
- 8. Resiliency • The ability to recover quickly from illness, change, or misfortune • Being able to “bounce back” • The process of adap9ng well • Involves behaviors, thoughts, and ac9ons that can be learned • Is not without difficulty or distress American Psychological Associa1on, 2010; The American Heritage® Dic1onary, Fourth Edi1on, rev 2009. Ψ © 2010 Serber
- 9. Living with Resiliency • Benefit-‐finding / Posbrauma9c growth • Faith • Social Support • Posi9vity and op9mism • Humor • Flexibility • Sedng Goals • Hope Ψ © 2010 Serber
- 10. Resilience Factors & Health • ↓ risk of coronary heart disease • ↓ cardiovascular events • ↓ mortality • ↓ rehospitaliza9on afer CABG • ↓ CVD progression • ↑ recovery from event • ↑ mental health and social func9oning • ↑ general health Cohen & Pressman, 2006; Giltay et al., 2006; Kubzansky et al., 2001; Middleton & Byrd, 1996; Scheier et al., 1989, 1999; Sears, Serber, et al., 2004; Tindle et al., 2009 Ψ © 2010 Serber
- 11. Cardiac Health is Behavioral Health • Minimize stress • Work less hours • Stop smoking – & abusing other substances • Physical ac9vity • Ea9ng healthy • Watching your weight • Enjoying life • Adequate sleep Ψ © 2010 Serber
- 12. Post-‐SCA Concerns • Vulnerability & mortality – Vs. new lease on life • Search for coherence • Search for meaning • Iden9ty • Control • Acceptance Ψ © 2010 Serber
- 13. ICD-‐Specific Concerns • Dependence on the box – life-‐threatening vs. life-‐saving • Device func9on and malfunc9oning • Shock • Daily func9oning • Body Image Ψ © 2010 Serber
- 14. How will shock affect me? • “Swif kick in the chest” • Rated as a “6” on a 0 -‐ 10 pain scale. • ICD shock is ofen the primary culprit to poor QOL • Anxiety or depression ~ 13-‐38% • Avoidance • Hypervigilance • No changes Sears et al., 2005 Ψ © 2010 Serber
- 15. The Struggle (Growth vs. Stress) • Mental recovery alongside physical recovery • Apprecia9on vs. apprehension • Return to occupa9onal and recrea9onal ac9vi9es • Fear and avoidance of ac9vi9es • Rose or grey colored glasses Ψ © 2010 Serber
- 16. What does surviving a cardiac arrest mean to you? Ψ © 2010 Serber
- 17. Coping Strategies DO – • Keep doing what you love doing • Set (new) goals and accomplish them • Unless otherwise directed, you do not need to change how you enjoy living life • Engage in heart healthy behaviors – Physical ac9vity – good for body and mind – Eat right – Relax and rest Ψ © 2010 Serber
- 18. Coping Strategies EDUCATE YOURSELF • Knowledge is power! – Disease state and “normal” progression – About your ICD and how it works – How to respond to a cardiac event /shock • Seek informa9on: – Health care providers – Mental health/behavioral professionals – Other SCA survivors – Support group – www.icdsupportgroup.org Ψ © 2010 Serber
- 19. Coping Strategies BE PREPARED – • Keep the following informa9on with you at all 9mes. – ICD Iden9fica9on card – Medical jewelry – Current list of medica9ons/allergies – Physician’s name and phone number This informa9on will help health care providers take care of you in an emergency. Sears et al., 2005 Ψ © 2010 Serber
- 20. Shock Plan • Ac9on plan with your physicians and family to prepare for an ICD shock – Write it down and spread the word! • What to do medically – When to call in or receive medical care • What to do psychologically – Stay or find calm: • Breathe, talk, surround self with loved ones, carry on with ac9vi9es • Carry it with you Ψ Sears et al., 2005 © 2010 Serber
- 21. Why is your emo:onal health so important? Not only for your well-‐being, but also your health Ψ © 2010 Serber
- 22. Nega:ve Emo:on, Distress, & CVD • Poor self-‐care and health behaviors • Cardiac events – Ischemia – Infarc9on – Arrhythmias and cardiac arrest • Provoke 20% of life-‐threatening arrhythmias or SCD • Provoke ischemia in 50% of chronic IHD Ahern et al., 1990; Burg et al., 1993; Dimsdale, 2008; Dunbar et al., 2001; Jain, 2008; Lampert et al., 2002; Lampert et al., 2009; MiVleman et al., 1995; Muller et al., 1999; Ramachandruni et al., 2006; Rozanski & Blumenthal, 2005; Shedd et al., 2004; Smith & Ruiz, 2002; Ziegelstein, 2007 Ψ © 2010 Serber
- 23. This is to encourage you to hold onto what is good “The future’s so bright, [you] go[a wear shades.” Ψ © 2010 Serber
- 24. If you start to struggle, you may feel like this: • Feeling depressed, down, “blah,” or hopeless • ↓ interest, pleasure in enjoyable ac9vi9es • ↓ mo9va9on to engage in ac9vi9es • Feeling “wound up,” nervous, on edge, or worrying a lot Ψ © 2010 Serber
- 25. Other symptoms of distress are physical: • Difficult to dis9nguish from cardiac symptoms: – ↑ heart rate – Fa9gue – ↑ respiratory rate – Change in sleep – SOB – Chest pain Ψ © 2010 Serber
- 26. Distress also affects what you do: • Avoid ac9vi9es • Avoid people • Reduced self-‐care • Change in ea9ng/ appe9te • Change in sleep Ψ © 2010 Serber
- 27. Stress-‐Management Techniques Ψ © 2010 Serber
- 28. Diaphragma@c / Belly Breathing Ψ © 2010 Serber
- 29. Guided Imagery • Take yourself to a peaceful, safe place (place you know or imagine) • Ac9vate all 5 senses: sight, smell, taste, touch, hear Ψ © 2010 Serber
- 30. Thought Management • Iden9fy automa9c nega9ve thoughts • Iden9fy possible “cogni9ve distor9ons” • Challenge and replace nega9ve thoughts • Find a “posi9ve” – In the situa9on or another area of your life – Blessings, affirma9ons, accomplishments Ψ © 2010 Serber
- 31. Thought Management • E.g., “I am never going for a walk in the park again.” “The walk or the park did not cause the SCA/shock.” – “I have been treated and encouraged to be ac9ve.” and/or “This device allows me to do what I want!” – Can take it further: “Next 9me I will pay aben9on to how I am feeling and will also have my cell phone with me.” • E.g., Shock episode – “I am going to die.” “the shock was painful and disrup9ve, but it just saved my life.” Ψ © 2010 Serber
- 32. Know When to Get Help • Change in mood or temperament • Change in sleep • Change in appe9te • Low tolerance for people or ac9vi9es • Feel confused, lost, helpless, hopeless • “Can’t be bothered” to take care of yourself • Reduced interest in ac9vi9es you usually enjoy When your own strategies aren’t working… Ψ © 2010 Serber
- 33. Benefits of Psychological/ Behavioral Interven:ons • ↑ psychological well-‐being and QOL • ↑ exercise capacity and physical fitness • ↑ physiology • ↓ physical symptoms Chevalier et al., 2006; FitcheV et al., 2003; Frizelle et al., 2004; Pedersen et al., 2007; Sears et al., 2009 Ψ © 2010 Serber
- 34. Thank you Ques9ons? Ψ © 2010 Serber