Romano Endrighi1,2, Andrew J Dimond1, Andrew J Waters1, Christopher C Dimond3, Kristie M Harris4, Stephen S Gottlieb5, David S Krantz1. 1. Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA. 2. Center for Behavioral Science Research, Department of Health Policy, Health Services Research, Boston University Henry M. Goldman School of Dental Medicine , Boston , MA , USA. 3. Center for Biology and Society, Arizona State University , Tempe , AZ , USA. 4. Section on Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven , CT , USA. 5. Department of Medicine, University of Maryland School of Medicine , Baltimore , MD , USA.
Abstract
Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant. Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.
Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant. Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.
Authors: Kristie M Harris; John S Gottdiener; Stephen S Gottlieb; Matthew M Burg; Shuying Li; David S Krantz Journal: J Card Fail Date: 2020-08-01 Impact factor: 5.712
Authors: Kristie M Harris; Daniel L Jacoby; Rachel Lampert; Richard J Soucier; Matthew M Burg Journal: Heart Fail Rev Date: 2020-11-20 Impact factor: 4.214
Authors: Allison E Gaffey; Sangchoon Jeon; Samantha Conley; Daniel Jacoby; Garrett I Ash; Henry K Yaggi; Meghan O'Connell; Sarah J Linsky; Nancy S Redeker Journal: Behav Sleep Med Date: 2020-05-12 Impact factor: 2.964