• Stress and anger appear to make heart disease worse
• Pandemic-related stressors may further exacerbate the situation  
• More work is needed to find out if stress management can improve outcomes for heart failure patients

If you suffer from heart failure, try to stay calm. Stress and anger may make your condition worse, a new study suggests.

Mental stress is common in heart failure patients due to the complexities of managing the disease, progressively worsening function, and frequent medical issues and hospitalisations, according to lead author Kristie Harris, a postdoctoral associate in cardiovascular medicine at Yale University in New Haven, Connecticut.

“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,” Harris said in a university news release.

Mental stress test

“Clarifying the relevant behavioural 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 added.

The new study included 24 heart failure patients who completed daily questionnaires for one week about their stress, anger and negative emotions.

That was followed by a mental stress test in which the patients solved maths problems and described a recent stressful experience. Echocardiograms were done to assess diastolic heart function at rest and during stress.

Diastolic function is the heart’s ability to relax and refill between beats. In heart failure, a damaged or weakened heart doesn’t pump as much blood as the body needs – a condition that can be life-threatening.

Patients who reported experiencing anger in the week before the mental stress test had worse resting diastolic pressure, the researchers found.

Stress management

According to senior study author Matthew Burg, “Factors such as mental stress and anger often go unrecognised and are under-addressed. This study contributes to the extensive literature showing that stress and anger affect clinical outcomes for patients with heart disease, adding chronic heart failure to the list that includes ischaemic heart disease (narrowed arteries) and arrhythmic disease.”

Burg, a clinical psychologist at Yale, said more work is needed to identify factors that increase vulnerability to stress in heart failure, and to find out if stress management can improve outcomes for these patients.

The study findings were published online recently in the Journal of Cardiac Failure.

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