Psychological stress and short-term hospitalisations or death in patients with heart failure

Abstract

Objective Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in HF patients. We investigated prospective associations of psychological stress with AEs in patients with HF. Methods 144 HF patients (77% male; 57.5±11.5, range 23–87 years, LVEF≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale; PSS) and AEs (CV hospitalizations/death) at 2-week intervals for 3 months, and at 9-month follow- up. Results 42 patients (29.2%) had at least one CV hospitalization and 9 (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared to those with lower stress (OR=1.10, 95% CI=1.04, 1.17). In contrast to average levels, increases in stress did not predict AEs (p=.96). Perceived stress was elevated after a CV hospitalization (B=2.70, SE=0.93, p=.004) suggesting that CV hospitalizations increase stress. Subsequent analysis indicated that (24 of 38; 63%) of patients showed a stress increase following hospitalization. However, a prospective association between stress and AEs was present when accounting for prior hospitalizations (B=2.43, SE=1.23, p=.05). Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalization occurs in many, but not all, HF patients. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalizations.

Psychosocial Stress and Cardiovascular Disease

“…Whereas APS is known to associate with acute left ventricular dysfunction as in Takotsubo cardiomyopathy, CPS has also been shown to have adverse outcomes in established heart failure (HF) patients. Endrighi et al showed in a prospective study that CPS was a significant predictor of cardiovascular morbidity and all-cause mortality in HF patients [73]. The association between CPS and incident HF is rather weak and has largely been reported in individuals with poor health at baseline [74].…”

Self‐care of patient and caregiver DyAds in multiple chronic conditions: A LongITudinal studY (SODALITY) protocol

“…In the present project, we have defined these predictors as "dyad-related" because they will be measured in both patients and caregivers. The results of individual studies conducted on DM, COPD and HF patients have shown that self-care is poorer when patients and caregivers are stressed (Endrighi et al, 2016;Kaptein et al, 2009;Dionne-Odom et al, 2017), are depressed (Bourbeau & Bartlett, 2008 Vellone et al, 2017) conducted on patients (Riegel & Dickson, 2008) and caregivers . According to these two theoretical studies, self-care maintenance influences self-care monitoring and self-care monitoring influences self-care management.…”

Perceived Stress After Acute Myocardial Infarction: A Comparison Between Young and Middle-Aged Women Versus Men

“…To further elucidate how recurrent cardiac events might alter the trajectory of perceived stress post-AMI (29), we performed a sensitivity analysis examining sex difference in PSS-14 scores over time among patients with versus without post-AMI angina separately. Patients with an SAQ angina frequency score less than 100 at either 1-month or 12-month interviews were regarded as having angina post-AMI, while those with a score of 100 at both interviews were considered as not having angina post-AMI.…”