The relationship between mindfulness and enduring somatic threat severity in long-term cardiac arrest survivors.
Open accessAbstract
Background: Cardiac arrest (CA) survivors experience continuous exposures to potential traumas though chronic cognitive, physical and emotional sequelae and enduring somatic threats (ESTs) (i.e., recurring somatic traumatic reminders of the event). Sources of ESTs can include the daily sensation of an implantable cardioverter defibrillator (ICD), ICD-delivered shocks, pain from rescue compressions, fatigue, weakness, and changes in physical function. Mindfulness, defined as non-judgmental present-moment awareness, is a teachable skill that might help CA survivors cope with ESTs. Here we describe the severity of ESTs in a sample of long-term CA survivors and explore the cross-sectional relationship between mindfulness and severity of ESTs. Methods: We analyzed survey data of long-term CA survivors who were members of the Sudden Cardiac Arrest Foundation (collected 10–11/2020). We assessed ESTs using 4 cardiac threat items from the Anxiety Sensitivity Index-revised (items range from 0 "very little" to 4 "very much") which we summed to create a score reflecting total EST burden (range 0–16). We assessed mindfulness using the Cognitive and Affective Mindfulness Scale-Revised. First, we summarized the distribution of EST scores. Second, we used linear regression to describe the relationship between mindfulness and EST severity adjusting for age, gender, time since arrest, COVID-19-related stress, and loss of income due to COVID. Results: We included 145 CA survivors (mean age: 51 years, 52% male, 93.8% white, mean time since arrest: 6 years, 24.1% scored in the upper quarter of EST severity). Greater mindfulness (β: -30, p = 0.002), older age (β: -0.30, p = 0.01) and longer time since CA (β: -0.23, p = 0.005) were associated with lower EST severity. Male sex was also associated with greater EST severity (β: 0.21, p = 0.009). Conclusion: ESTs are common among CA survivors. Mindfulness may be a protective skill that CA survivors use to cope with ESTs. Future psychosocial interventions for the CA population should consider using mindfulness as a core skill to reduce ESTs.
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Cites
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Claims the paper makes
3 of 10 cited sources checked · 3 supported · 0 flagged
- Premisecitation
In an earlier analysis of this sample, higher mindfulness correlated with less emotional distress.
“Indeed, in a previous analysis of the present sample, greater mindfulness was associated with lower emotional distress (Presciutti et al., 2022b).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Presciutti et al., 2022b source
- Findingown data
Longer time since cardiac arrest is associated with lower EST severity in long-term cardiac arrest survivors after adjustment.
“older age (β: -0.30, p = 0.01) and longer time since CA (β: -0.23, p = 0.005) were associated with lower EST severity.”
- Also stated in: § Results · plain
“Older age (β: -0.30, p = 0.01) and greater time since the CA (-0.23, p = 0.005) were also associated with lower EST severity.”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data
The adjusted linear regression model accounted for 39% of the variance in EST scores.
“Our model explained 39% of the variance in EST score.”
- Also stated in: § Limitations · plain
“our model explained only 39% of the variance in ESTs”
Quote in the paperSubstantial claim - Also stated in: § Limitations · plain
- Findingown data
Older age is associated with lower EST severity in long-term cardiac arrest survivors after adjustment.
“older age (β: -0.30, p = 0.01) and longer time since CA (β: -0.23, p = 0.005) were associated with lower EST severity.”
- Also stated in: § Results · plain
“Older age (β: -0.30, p = 0.01) and greater time since the CA (-0.23, p = 0.005) were also associated with lower EST severity.”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data
Male sex is associated with greater EST severity in long-term cardiac arrest survivors after adjustment.
“Male sex was also associated with greater EST severity (β: 0.21, p = 0.009).”
- Also stated in: § Results · plain
“Male sex was associated with greater EST severity (β: 0.21, p = 0.009).”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Interpretationown data
Mindfulness might serve as a protective capacity for cardiac arrest survivors in managing enduring somatic threats.
“Mindfulness may be a protective skill that CA survivors use to cope with ESTs.”
- Also stated in: § Conclusion · hedged
“Mindfulness may be a potential protective skill that CA survivors can use to cope with ESTs, though this must be confirmed in longitudinal study.”
Quote in the paperSubstantial claim- Rests on an assumption: The CAMS-R validly measures mindfulness in long-term cardiac arrest survivors.
- Also stated in: § Conclusion · hedged
- Interpretationown data
Enduring somatic threats are common among long-term cardiac arrest survivors.
“ESTs are common among CA survivors.”
- Also stated in: § Discussion · plain
“Here, we provide quantitative support that a significant proportion of CA survivors experience ongoing ESTs years after their arrest.”
- Also stated in: § Conclusion · plain
“ESTs are common in a sample of long-term CA survivors.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Premisecitation
Earlier trials of mindfulness exercises among ICD recipients successfully lowered anxiety and distress.
“previous interventions in ICD recipients that focused on mindfulness-based exercises were efficacious in reducing anxiety and distress (Irvine et al., 2011; Qintar et al., 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Irvine et al., 2011; Qintar et al., 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Study design and conductreasoning
The cross-sectional design prevents determining whether mindfulness affects EST severity or the reverse.
“given that this study was cross-sectional, we cannot discern the direction of the relationship between mindfulness and EST severity.”
Quote in the paperSubstantial claim - Interpretationreasoning
Younger survivors may find cardiac arrest more shocking and traumatic, as major medical events are less expected at their age.
“Experiencing a CA may be more surprising and traumatic for younger survivors, given their lower likelihood of experiencing major medical events.”
Quote in the paperNot a substantial claim - Premisecitation
Survivors of cardiac arrest continue to encounter possible traumatic experiences during recovery and beyond.
“Patients who are resuscitated from CA and recover consciousness (“CA survivors”) experience continuous exposures to potential traumas throughout their recovery and survivorship (Gamper et al., 2004; Presciutti et al., 2021, 2022a; Sawyer et al., 2020; Wilder Schaaf et al., 2013).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Gamper et al., 2004; Presciutti et al., 2021, 2022a; Sawyer et al., 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Classified as probably not a substantial claim. 7
- May combine two claims. 10
- The quote only partly states this claim. 1
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe CAMS-R has received validation among HIV-positive individuals in Myanmar.
“has been validated in people living with HIV in Myanmar (Huang et al., 2021).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Huang et al., 2021 source
Classified as probably not a substantial claim. May combine two claims.
Study design and conductcitationThe study assessed ESTs using four ASI-R cardiac threat items, following a prior acute coronary syndrome study, in the absence of an established EST measure.
“Our approach to measuring ESTs is consistent with a previous study that examined ESTs in acute coronary syndrome patients (Meli et al., 2019).”
- Also stated in: § Limitations · plain
“in the absence of an established EST measure, we instead utilized the four cardiac threat items from Anxiety Sensitivity Index, following the method of a previous study of EST in acute coronary syndrome patients (Meli et al., 2019).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Meli et al., 2019 source
- Also stated in: § Limitations · plain
May combine two claims.
Findingown dataThe analyzed sample consisted of 145 long-term cardiac arrest survivors with a mean age of 51 years, 52% male, 93.8% white, and a mean of 6 years since arrest.
“We included 145 CA survivors (mean age: 51 years, 52% male, 93.8% self-identified as white, mean time since arrest: 6 years).”
- Also stated in: § Results · plain
“We included 145 CA survivors (mean age: 51 years, 52% male, 93.8% white, mean time since arrest: 6 years, 24.1% scored in the upper quarter of EST severity).”
Quote in the paperNot a substantial claim- Also stated in: § Results · plain
The quote only partly states this claim.
Findingown dataGreater mindfulness is associated with lower enduring somatic threat severity in long-term cardiac arrest survivors after accounting for age, sex, interval since arrest, pandemic-related stress, and pandemic-related income loss.
“Greater mindfulness (β: -30, p = 0.002), older age (β: -0.30, p = 0.01) and longer time since CA (β: -0.23, p = 0.005) were associated with lower EST severity.”
- Also stated in: § Results · plain
“Greater mindfulness was associated with lower EST severity (β: -0.30, p = 0.002).”
Quote in the paperSubstantial claim- Rests on an assumption: The CAMS-R validly measures mindfulness in long-term cardiac arrest survivors.
- Also stated in: § Results · plain
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataIn this sample, EST severity scores spanned the 0-16 range, with 27.6% in the first quartile, 27.6% in the second, 20.6% in the third, and 24.1% in the upper quartile.
“The distribution of EST scores was as follows: first (lower) quarter (0–3): 27.6%, second quarter (4–7): 27.6%, third quarter (8–11): 20.6%, fourth (upper) quarter (12–16): 24.1%.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAn earlier cardiac arrest survivor study reported that cardiac-related anxiety was more common among younger patients.
“a previous study of CA survivors also showed that younger survivors were more likely to experience cardiac-related anxiety (Rosman et al., 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rosman et al., 2015 source
May combine two claims.
Study design and conductown dataThe study used a convenience sample of SCAF members who were mostly white and had good neurologic recovery, limiting how representative the findings are.
“our convenience sample predominantly self-identified as white, experienced good neurologic recovery, and were all SCAF members, which limits the representativeness of our findings.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Study design and conductreasoningSCAF members probably encounter survivorship subjects like mindfulness and ESTs more often than typical cardiac arrest survivors, and their answers may reflect availability bias.
“SCAF members are likely more exposed to survivorship topics, such as mindfulness and ESTs, than the average CA survivor, and may have had an availability bias in their response pattern to our study’s measures.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationMany cardiac arrest survivors are surprised by these aftereffects and lack preparation for handling them.
“Second, they often do not expect to experience these sequelae and are unprepared to manage them when they occur (Sawyer et al., 2016, 2020; Presciutti et al., 2022a).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Sawyer et al., 2016, 2020; Presciutti et al., 2022a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Study design and conductown dataThe study omitted medication and clinical arrest variables usually obtained from charts, which might have helped explain post-arrest ESTs.
“we did not collect pharmacological or CA clinical characteristics typically extracted from medical records, which both may have been relevant for better understanding ESTs post-CA.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationSources of post-arrest ESTs include device sensations or shocks, pain from resuscitation, tiredness, weakness, altered physical function, awareness of heart-rate changes, cognitive shifts, and other somatic reminders of the event.
“Sources of post-CA ESTs can include the daily sensation of an implantable cardioverter defibrillator (ICD) in those who received ICDs, ICD-delivered shocks, pain from rescue compressions, fatigue, weakness, changes in physical function, sensitivity to changes in heart rate, cognitive changes, and any other threatening somatic reminder of the CA event (Pedersen et al. 2005; Presciutti et al. 2022a;”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pedersen et al. 2005; Presciutti et al. 2022a; Qintar et al. 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationEnduring somatic threats remind survivors of their body's fragility and death, concerns that are particularly relevant after cardiac arrest.
“ESTs serve as reminders of the vulnerability of one’s body and mortality (Meli et al., 2019), which are two issues that are particularly present in the CA population (Bremer et al., 2019; Sawyer et al., 2020).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Meli et al., 2019; Bremer et al., 2019; Sawyer et al., 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationAfter cardiac arrest, survivors often face abrupt declines in thinking and physical ability due to brain injury, and these problems frequently persist.
“First, they must contend with sudden losses in cognitive and physical abilities from brain injury, which often become chronic problems (Harrod et al., 2021; Moulaert et al., 2009; Sawyer et al., 2020; Presciutti et al., 2022a).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Harrod et al., 2021; Moulaert et al., 2009; Sawyer et al., 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningThe male-sex association with higher EST severity might reflect that SCAF's voluntary membership draws survivors who are more distressed than those recruited consecutively in clinical settings.
“This finding may be related to the recruitment source such that SCAF membership is opt-in and may attract survivors who are more likely to endorse and/or experience emotional distress than those consecutively enrolled in a medical setting.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Before this study, no research had measured the severity of ESTs in the post-cardiac-arrest population.
“no studies have quantified the severity of ESTs post-CA.”
The paper relies on this without support.
Before this study, the connection between mindfulness and ESTs after cardiac arrest had not been investigated.
“The relationship between mindfulness and ESTs post-CA, however, has not yet been explored.”
The paper relies on this without support.
The CAMS-R validly measures mindfulness in long-term cardiac arrest survivors.
“We assessed mindfulness using the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) (Feldman et al., 2007).”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Mindfulness coefficient differs between abstract and results
MinorThe abstract reports a mindfulness coefficient of -30, while the Results section reports -0.30 for the same association. The discrepancy changes the reported magnitude by a factor of 100.
“Greater mindfulness (β: -30, p = 0.002)”
“Greater mindfulness was associated with lower EST severity (β: -0.30, p = 0.002).”
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“Mindfulness is a teachable skill that could be taught to CA survivors to cope with ESTs. ESTs invasively distract survivors from the present moment by way of threatening bodily reminders of the CA (Edmondson et al., 2018).”
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Bremer, A., Dahné, T., Stureson, L., Årestedt, K., & Thylén, I. (2018) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12616 · Cited by 32 · cited 1× · see citing works
“ESTs serve as reminders of the vulnerability of one’s body and mortality (Meli et al., 2019), which are two issues that are particularly present in the CA population (Bremer et al., 2019; Sawyer et al., 2020 ).”
Presciutti, A., Siry-Bove, B., Newman, M. M., Elmer, J., Grigsby, J., Masters, K., Shaffer, J., Vranceanu, A.-M., & Perman, S. (2022) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.121.025713 · Cited by 32 · cited 3× · see citing works
“Second, they often do not expect to experience these sequelae and are unprepared to manage them when they occur (Sawyer et al., 2016, 2020; Presciutti et al., 2022a).”
Self-citationQintar, M., George, J. J., Panko, M., Bea, S., Broer, K. A., St. John, J., Blissett, K.-A., Ching, E., Sears, S. F., Pedersen, S. S., et al. (2015) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-015-9990-7 · Cited by 30 · cited 2× · see citing works
“Notably, however, previous interventions in ICD recipi - ents that focused on mindfulness-based exercises were efficacious in reducing anxiety and distress (Irvine et al., 2011; Qintar et al., 2015).”
Presciutti, A., Newman, M. M., Grigsby, J., Vranceanu, A.-M., Shaffer, J., & Perman, S. (2021) · Resuscitation Plus · doi:10.1016/j.resplu.2021.100085 · Cited by 26 · cited 1× · see citing works
“Patients who are resuscitated from CA and recover con - sciousness (“CA survivors”) experience continuous expo - sures to potential traumas throughout their recovery and survivorship (Gamper et al., 2004; Presciutti et al., 2021, 2022a; Sawyer et al., 2020; Wilder Schaaf et al., 2013).”
Self-citationHarrod, M., Kamphuis, L. A., Hauschildt, K., Seigworth, C., Korpela, P. R., Rouse, M., Vincent, B. M., Nallamothu, B. K., & Iwashyna, T. J. (2021) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2021.100002 · Cited by 19 · cited 1× · see citing works
“First, they must contend with sudden losses in cognitive and physical abilities from brain injury, which often become chronic problems (Harrod et al., 2021; Moulaert et al., 2009; Sawyer et al., 2020; Presciutti et al., 2022a).”
Mace, R., Doorley, J. D., Bakhshaie, J., Cohen, J., & Vranceanu, A.-M. (2021) · Journal of Neuro-Oncology · doi:10.1007/s11060-021-03852-1 · Cited by 17 · cited 1× · see citing works
“…populations, including neurocritical care (Choi et al., 2018; Meyers et al., 2020 ; Shaffer et al., 2016; Vranceanu et al., 2020), chronic pain (Greenberg et al., 2020 ), and neurofibromatosis (Mace et al., 2021) and has been validated in people living with HIV in Myanmar (Huang et al., 2021).”
Self-citationHuang, F., Chen, W.-T., Shiu, C.-S., Lin, S. H., Tun, M. S., Nwe, T. W., Nu Oo, Y. T., & Oo, H. N. (2022) · Mindfulness · doi:10.1007/s12671-021-01784-5 · Cited by 11 · cited 2× · see citing works
“…populations, including neurocritical care (Choi et al., 2018; Meyers et al., 2020 ; Shaffer et al., 2016; Vranceanu et al., 2020), chronic pain (Greenberg et al., 2020 ), and neurofibromatosis (Mace et al., 2021) and has been validated in people living with HIV in Myanmar (Huang et al., 2021).”
Presciutti, A., Shaffer, J., Newman, M. M., & Perman, S. (2020) · Resuscitation Plus · doi:10.1016/j.resplu.2020.100008 · Cited by 8 · cited 2× · see citing works
“Our study contributes to previous reports of CA survivors that described experiences consistent with ESTs (Presciutti et al., 2020a; Rosman et al., 2015; Sawyer et al., 2016).”
Self-citationPresciutti, A., Greenberg, J., Lester, E., Newman, M. M., Elmer, J., Shaffer, J. A., Vranceanu, A.-M., & Perman, S. M. (2022) · Journal of Behavioral Medicine · doi:10.1007/s10865-022-00295-5 · Cited by 4 · cited 7× · see citing works
“Second, they often do not expect to experience these sequelae and are unprepared to manage them when they occur (Sawyer et al., 2016, 2020; Presciutti et al., 2022a).”
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F., S. S., R., H., A., S., E., J., S., A., Z., H., & R., N. (2023) · Current Cardiology Reports · doi:10.1007/s11886-023-01924-4 · Cited by 18 · see citing works
Protective positive psychology factors and emotional distress after cardiac arrest.
Presciutti, A., Flickinger, K. L., Coppler, P. J., Ratay, C., Doshi, A., Perman, S., Vranceanu, A.-M., & Elmer, J. (2023) · Resuscitation · doi:10.1016/j.resuscitation.2023.109846 · Cited by 13 · see citing works
Self-citationCamera, D. L., Elmer, J., Perman, S. M., Donnino, M. W., Wu, O., Parker, R. A., Vranceanu, A., & Presciutti, A. (2025) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2024.101426 · Cited by 5 · see citing works
Self-citationPTSD Following an Acute Cardiac Event: A Case Treated With Prolonged Exposure
Spencer-Laitt, D., Magoon, C., Preda, A. M., Ishikawa, R. Z., & Baker, A. W. (2024) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2024.12.003 · Cited by 2 · see citing works
Psychological and cognitive support after cardiac arrest: a systematic review
Ristagno, G., Cerchiari, E., Madotto, F., Cucino, A., Magliocca, A., Merigo, G., Boverio, R., Ranzato, K., Scapigliati, A., Semeraro, F., et al. (2026) · Resuscitation Plus · doi:10.1016/j.resplu.2026.101450 · Cited by 1 · see citing works
“16,34 8 Poor (high risk of bias) NIH Before–”
- Authors
- Presciutti, A. M., Bannon, S. M., Yamin, J. B., Newman, M. M., Parker, R. A., Elmer, J., Wu, O., Donnino, M. W., Perman, S. M., & Vranceanu, A.-M.
- Affiliations
- Harvard University (US)
- Beth Israel Deaconess Medical Center (US)
- University of Pittsburgh (US)
- University of Colorado Anschutz (US)
- ORCID
- Venue
- Journal of Behavioral Medicine
- Published
- 2023-03-09
- Volume
- 46
- Issue
- 5
- Pages
- 890-896
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- PMC
- PMC9995732
- OpenAlex
- W4323652482
- Cited by
- 5
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Behavioral Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Advancing Translational Sciences (TL1 TR002533)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- cardiac arrest survivors, mindfulness, anxiety sensitivity, implantable cardioverter-defibrillator, ICD shocks, post-traumatic stress, sex differences, COVID-19 stress, psychosocial interventions
- MeSH terms
- COVID-19, Anxiety, Female, Heart Arrest, Humans, Male, Middle Aged, Survivors, Mindfulness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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