Examination of the potential association of stress with morbidity and mortality outcomes in patient with heart failure

Abstract

Objectives:The high mortality and morbidity rates associated with heart failure are still not well explained. A few psychosocial factors have been studied and explain some of this risk, but other factors, like stress, remain largely unexplored in heart failure. This study aimed to (1) examine the association of stress with 6-month cardiac event-free survival, (2) examine the relationship of stress with salivary cortisol, and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival.Method:A total of 81 heart failure patients participated. Stress was measured using the brief Perceived Stress Scale. Cortisol was measured from unstimulated whole expectorated saliva. Cox regression analyses were used to determine whether stress predicted event-free survival, and if salivary cortisol predicted event-free survival. Linear and multiple regressions were used to determine the association of stress with salivary cortisol.Results:Stress was not a significant predictor of event-free survival in heart failure (heart rate = 1.06; 95% confidence interval = 0.95–1.81; p = 0.32). Salivary cortisol was a significant predictor of event-free survival in the unadjusted model (heart rate = 2.30; 95% confidence interval = 0.99–5.927; p = 0.05), but not in the adjusted model. Stress (β 1.06; 95% confidence interval = 0.95–1.18; p = 0.32) was not a significant predictor of salivary cortisol level.Conclusion:Stress is a complex phenomenon, and our measure of stress may not have captured it well. Alternatively, the physical stressors acting in heart failure produce levels of neurohormonal activation that mask the effects of psychosocial stressors or an indirect association of stress with outcomes that is mediated through another construct. Future studies are needed to investigate stress in patients with heart failure to provide definitive answers.

Stress, cognitive appraisal, coping, and event free survival in patients with heart failure

“…This result can be explained by the association of the harm/loss cognitive appraisal with other negative psychosocial factors such as depression and anxiety that been found to short event free survival among HF patients. 46,47 Healthcare providers must assist patients to learn and use more positive types of appraisal and coping in response to stress. Cognitive behavioral therapy is effective in assisting patients assume healthier appraisal and coping strategies, which are associated with better health outcomes, greater self-efficacy, and less depression and anxiety.…”

Salivary Biomarkers for Diagnosis and Therapy Monitoring in Patients with Heart Failure. A Systematic Review

“…Fifteen studies fulfilled the inclusion criteria [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Among these studies, eighteen separate salivary biomarkers were analyzed; salivary amylase, mainly its major form salivary alpha amylase (sAA), uric acid (UA), 8-isoprostaglandin F2α (8-isoPGF2α), lactate, galectin-3 (Gal-3), BNP, interleukin 6 (IL-6) and interleukin 10 (IL-10), CRP, protein S100-A7 (S10A7), cortisol, NT-proBNP, 8-epiprostaglandin F2α (8-epiPGF2α), endothelin, sodium, chloride, and potassium.…”

“…Saliva values of myoglobin, cardiac troponin I, creatine phosphokinase MB, myeloperoxidase, the natriuretic peptides (BNP and NT-proBNP), CRP, etc., have been used for the diagnosis of cardiovascular diseases in general and in most cases they have been found to correlate well with plasma concentrations [ 21 , 22 , 23 , 24 , 25 ]. On the other hand, very few have been tested specifically for HF diagnosis, monitoring and prognosis [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

Reliability and Physiological Interpretation of Pulmonary Gas Exchange by “Circulatory Equivalents” in Chronic Heart Failure

“…1 HF remains a progressive disease, and the associated exercise intolerance is the strongest correlate of morbidity and mortality. [2][3][4] Peak oxygen uptake ( _ VO 2peak ), 5 end-tidal gas tensions, 6 and oscillatory breathing 7,8 measured by cardiopulmonary exercise testing (CPET) are prognostic of mortality in HF, and _ VO 2peak and lactate threshold (LT) are used for risk stratification, such as to guide suitability for transplant. 4,[9][10][11] The relationship between ventilation ( _ V E ) and carbon dioxide output ( _ VCO 2 ) (either as the _ V E = _ VCO 2 slope, or the value of _ V E = _ VCO 2 at a specified submaximal metabolic rate; eg, at LT or the ventilatory compensation point [VCP]), typically provides one of the strongest prognosticators, [12][13][14] either independently or in combination with other CPET and non-CPET variables.…”

“…Chronic heart failure (HF) is characterized by dyspnea on exertion and exercise intolerance . HF remains a progressive disease, and the associated exercise intolerance is the strongest correlate of morbidity and mortality . Peak oxygen uptake (), end‐tidal gas tensions and oscillatory breathing measured by cardiopulmonary exercise testing (CPET) are prognostic of mortality in HF, and and lactate threshold (LT) are used for risk stratification, such as to guide suitability for transplant .…”