Psychological stress in heart failure: a potentially actionable disease modifier
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Psychological stress in heart failure: a potentially actionable disease modifier Kristie M. Harris1,2 · Daniel L. Jacoby1 · Rachel Lampert1 · Richard J. Soucier3 · Matthew M. Burg1,2,4 Accepted: 9 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Psychological stress is common in patients with heart failure, due in part to the complexities of effective disease self-management and progressively worsening functional limitations, including frequent symptom exacerbations and hospitalizations. Emerging evidence suggests that heart failure patients who experience higher levels of stress may have a more burdensome disease course, with diminished quality of life and increased risk for adverse events, and that multiple behavioral and pathophysiological pathways are involved. Furthermore, the reduced quality of life associated with heart failure can serve as a life stressor for many patients. The purpose of this review is to summarize the current state of the science concerning psychological stress in patients with heart failure and to discuss potential pathways responsible for the observed effects. Key knowledge gaps are also outlined, including the need to understand patterns of exposure to various heart failure-related and daily life stressors and their associated effects on heart failure symptoms and pathophysiology, to identify patient subgroups at increased risk for stress exposure and disease-related consequences, and the effect of stress specifically for patients who have heart failure with preserved ejection fraction. Stress is a potentially modifiable factor, and addressing these gaps and advancing the science of stress in heart failure is likely to yield important insights about actionable pathways for improving patient quality of life and outcomes. Keywords Heart failure · Psychological · Stress · Mental · Behavioral
Introduction Heart failure (HF) is a progressive disease with considerable variation in the clinical course. Patients who survive a first episode of acute HF subsequently experience an unpredictable trajectory, typically characterized by varying periods of symptom stability interspersed with episodes of decompensation. Generally, as HF progresses, symptom exacerbations become more frequent and recovery to prior health status less likely [1]. While underlying pathophysiology and * Kristie M. Harris [email protected] 1
treatment approaches play a pivotal role in this process, the course is also influenced by patient-level variables, including lifestyle, self-care and treatment adherence, and psychosocial factors [2–4]. Psychological stress is a less frequently considered but potential disease modifier. As a chronic, lifethreatening illness, HF is itself a potent stressor, and there is accumulating evidence that high levels of stress adversely impact HF disease progression [5–10]. In this focused review, we describe and evaluate the literature concerning stress and HF and identify critical knowledge gaps in need of further study, thereby setti
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