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

R. Endrighi , A.J. Waters, S.S. Gottlieb, K.M. Harris, A.J. Wawrzyniak, N.S. Bekkouche, Y. Li, W.J. Kop, D.S. Krantz

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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 patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF.
Methods
144 patients with HF (77% male; 57.5±11.5, range 23–87 years, left ventricular ejection fraction ≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up.
Results
42 patients (29.2%) had at least one CV hospitalisation and nine (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95% confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs (p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63%) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05).
Conclusions
Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.
Original languageEnglish
Pages (from-to)1820-1825
JournalHeart
Volume102
Issue number22
DOIs
Publication statusPublished - 2016

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Endrighi , R., Waters, A. J., Gottlieb, S. S., Harris, K. M., Wawrzyniak, A. J., Bekkouche, N. S., ... Krantz, D. S. (2016). Psychological stress and short-term hospitalisations or death in patients with heart failure. Heart, 102(22), 1820-1825. https://doi.org/10.1136/heartjnl-2015-309154
Endrighi , R. ; Waters, A.J. ; Gottlieb, S.S. ; Harris, K.M. ; Wawrzyniak, A.J. ; Bekkouche, N.S. ; Li, Y. ; Kop, W.J. ; Krantz, D.S. / Psychological stress and short-term hospitalisations or death in patients with heart failure. In: Heart. 2016 ; Vol. 102, No. 22. pp. 1820-1825.
@article{1156a4c4df214e2e8d43de1ea62662ef,
title = "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 patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF.Methods 144 patients with HF (77{\%} male; 57.5±11.5, range 23–87 years, left ventricular ejection fraction ≤40{\%}) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up.Results 42 patients (29.2{\%}) had at least one CV hospitalisation and nine (6.3{\%}) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95{\%} confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs (p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63{\%}) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05).Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.",
author = "R. Endrighi and A.J. Waters and S.S. Gottlieb and K.M. Harris and A.J. Wawrzyniak and N.S. Bekkouche and Y. Li and W.J. Kop and D.S. Krantz",
year = "2016",
doi = "10.1136/heartjnl-2015-309154",
language = "English",
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pages = "1820--1825",
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Endrighi , R, Waters, AJ, Gottlieb, SS, Harris, KM, Wawrzyniak, AJ, Bekkouche, NS, Li, Y, Kop, WJ & Krantz, DS 2016, 'Psychological stress and short-term hospitalisations or death in patients with heart failure', Heart, vol. 102, no. 22, pp. 1820-1825. https://doi.org/10.1136/heartjnl-2015-309154

Psychological stress and short-term hospitalisations or death in patients with heart failure. / Endrighi , R.; Waters, A.J.; Gottlieb, S.S.; Harris, K.M.; Wawrzyniak, A.J.; Bekkouche, N.S.; Li, Y.; Kop, W.J.; Krantz, D.S.

In: Heart, Vol. 102, No. 22, 2016, p. 1820-1825.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Psychological stress and short-term hospitalisations or death in patients with heart failure

AU - Endrighi , R.

AU - Waters, A.J.

AU - Gottlieb, S.S.

AU - Harris, K.M.

AU - Wawrzyniak, A.J.

AU - Bekkouche, N.S.

AU - Li, Y.

AU - Kop, W.J.

AU - Krantz, D.S.

PY - 2016

Y1 - 2016

N2 - 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 patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF.Methods 144 patients with HF (77% male; 57.5±11.5, range 23–87 years, left ventricular ejection fraction ≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up.Results 42 patients (29.2%) had at least one CV hospitalisation and nine (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95% confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs (p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63%) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05).Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.

AB - 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 patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF.Methods 144 patients with HF (77% male; 57.5±11.5, range 23–87 years, left ventricular ejection fraction ≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up.Results 42 patients (29.2%) had at least one CV hospitalisation and nine (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95% confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs (p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63%) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05).Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.

U2 - 10.1136/heartjnl-2015-309154

DO - 10.1136/heartjnl-2015-309154

M3 - Article

C2 - 27357124

VL - 102

SP - 1820

EP - 1825

JO - Heart

JF - Heart

SN - 1355-6037

IS - 22

ER -

Endrighi R, Waters AJ, Gottlieb SS, Harris KM, Wawrzyniak AJ, Bekkouche NS et al. Psychological stress and short-term hospitalisations or death in patients with heart failure. Heart. 2016;102(22):1820-1825. https://doi.org/10.1136/heartjnl-2015-309154