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Heart failure is worsened by stress and anger

A new study from Yale University suggests that stress and anger can worsen cardiovascular disease. Patients with heart failure were found to experience life-threatening symptoms shortly after dealing with negative emotions.

“Factors such as mental stress and anger often go unrecognized and are under-addressed,” said study senior author Matthew Burg. 

“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 ischemic heart disease (narrowed arteries) and arrhythmic disease.”

Heart failure is a condition in which the heart is damaged or weakened. The disease can cause the heart muscle to pump out less blood than usual, which is known as a reduced ejection fraction.

The researchers evaluated the effects of stress and anger on diastolic function among patients who had heart failure with reduced ejection fraction.

Diastolic function refers to the heart’s capacity to relax and refill between muscle contractions, and is an indicator of mortality risk.

For one week, the study participants reported daily on their experiences of stress and anger during the previous 24 hours. Next, the individuals completed a standardized “mental stress” assessment during which they solved challenging math problems and described a recent stressful experience. Echocardiograms were used to measure diastolic function during the stress task and also while the individuals were at rest.

According to the researchers, patients who reported experiencing anger in the week prior to the lab testing exhibited worse baseline resting diastolic pressure.

Stress-provoked changes in diastolic function, including decreased early relaxation and increased diastolic pressure, were observed in most patients.

“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 study lead author Kristie Harris, who is 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.”

According to Burg, stress management and related techniques have been shown to reduce risk for adverse events among patients with ischemic heart disease. However, he said that further research is needed to identify factors that increase vulnerability to the effects of stress in heart failure, and to determine whether stress management may improve health outcomes.

The study is published in the Journal of Cardiac Failure.

By Chrissy Sexton, Staff Writer


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