Patients with heart failure may have more mental stress and anger, according to a new report published in the Journal of Cardiac Failure. Factors such as mental stress and anger often go unrecognized, but researchers are now making a connection with how it can affect those with heart problems.
Heart failure is a cardiovascular disease where the heart is weakened or damaged. This can commonly lead to a reduced ejection fraction where the heart muscle pumps out a lower amount of blood than what is normal with each contraction. For the study, researchers analyzed patients who had heart failure with reduced ejection fraction.
Researchers evaluated the effects of stress and anger on diastolic function as part of the study. Diastolic function explains the ability of the heart to relax and refill between muscle contractions. It can be predictive of mortality risk.
All participants were required to complete daily questionnaires about their level of stress, anger, and negative emotions during the previous 24 hours. They were then given a standardized “mental stress” protocol in which they solved challenging arithmetic problems and described a recent stressful experience. Patients were required to have an echocardiogram to assess diastolic function at rest and during the stress task.
The study found that patients who experienced anger in the week prior to the laboratory stress protocol showed worse baseline resting diastolic pressure. They also found that most patients demonstrated stress-provoked changes in diastolic function. This included decreased early relaxation and increased diastolic pressure.
“Mental stress is common in patients with heart failure due in part to the complexities of disease self-management, progressively worsening functional limitations, and frequent symptom exacerbations and hospitalizations,” said the lead author Kristie Harris, a postdoctoral associate in cardiovascular medicine at Yale.
“We have evidence that patients who experience chronically elevated levels of stress experience a more burdensome disease course with diminished quality of life and increased risk for adverse events. Clarifying the relevant behavioral and physiological pathways is especially important in the era of COVID-19 when the typical stressors of heart failure may be further compounded by pandemic-related stressors,” Harris said.
This study adds to the extensive research showing that stress and anger can affect clinical outcomes for patients with heart disease. Researchers are now able to add chronic heart failure to the list that includes ischemic heart disease (narrowed arteries) and arrhythmic disease.
Other studies have shown that stress management can help to reduce the risk for adverse events in patients with other heart health problems. However, more research is needed to identify factors that affect stress in those with heart failure and to determine if stress management could improve outcomes for those patients.