Derivation and validation of a predictive model for chronic stress in patients with cardiovascular disease
Ali O Malik1,2, Philip G Jones1,2, Carlos Mena-Hurtado3
1Saint Luke's' Mid America Heart Institute, Kansas City, MO, United States of America.
Insights
Chronic stress negatively impacts cardiovascular disease (CVD) outcomes. This study identified key risk factors for chronic stress in CVD patients, including female sex, smoking, and socioeconomic status, aiding targeted interventions.
Area of Science:
- Cardiology
- Psychosomatic Medicine
- Health Services Research
Background:
- Chronic stress is linked to poorer outcomes in cardiovascular disease (CVD), particularly peripheral artery disease (PAD).
- A reliable model to identify chronic stress risk factors in CVD patients is currently lacking.
- Understanding these factors is crucial for developing effective interventions.
Purpose of the Study:
- To develop and validate a predictive model for chronic stress in patients with cardiovascular disease.
- To identify demographic, socioeconomic, and clinical factors associated with chronic stress.
- To inform targeted interventions for high-risk CVD patients.
Main Methods:
- A logistic regression model was developed using data from 4,340 myocardial infarction (MI) patients in the TRIUMPH registry.
- Predictors of chronic stress (defined as ≥2 high Perceived Stress Scale scores over 1 year) were identified using 27 factors.
- The model was validated in 797 symptomatic PAD patients from the PORTRAIT registry.
Main Results:
- Female sex, current smoking, socioeconomic status, and economic burden were associated with higher chronic stress.
- Higher ENRICHD Social Support Instrument (ESSI) scores and older age were linked to lower chronic stress.
- The model demonstrated good predictive performance in both MI and PAD cohorts (c-statistic 0.77 in PAD).
Conclusions:
- A reliable model can identify independent predictors of chronic stress in CVD patients.
- Identified factors provide potential targets for interventions to mitigate chronic stress.
- This research highlights patient groups who could benefit most from stress-management strategies.
Background:
Chronic stress in patients with cardiovascular disease (CVD), including peripheral artery disease (PAD), is independently associated worse outcomes. A model that can reliably identify factors associated with risk of chronic stress in patients with CVD is needed.
Methods:
In a prospective myocardial infarction (MI) registry (TRIUMPH), we constructed a logistic regression model using 27 patient demographic, socioeconomic, and clinical factors, adjusting for site, to identify predictors of chronic stress over 1 year. Stress at baseline and at 1-, 6- and 12-month follow-up was measured using the 4-item Perceived Stress Scale (PSS-4) [range 0-16, scores ≥6 depicting high stress]. Chronic stress was defined as at least 2 follow-up PSS-4 scores ≥6. We identified and validated this final model in another prospective registry of patients with symptomatic PAD, the PORTRAIT study.
Results:
Our derivation cohort consisted of 4,340 patients with MI (mean age 59.1 ± 12.3 years, 33% females, 30% non-white), of whom 30% had chronic stress at follow-up. Of the 27 factors examined, female sex, current smoking, socioeconomic status, and economic burden due to medical care were positively associated with chronic stress, and ENRICHD Social Support Instrument (ESSI) score and age were inversely related to chronic stress. In the validation cohort of 797 PAD patients (mean age 68.6±9.7 years, 42% females, 28% non-white, 18% chronic stress) the c-statistic for the model was 0.77 and calibration was excellent.
Conclusions:
We can reliably identify factors that are independently associated with risk of chronic stress in patients with CVD. As chronic stress is associated with worse outcomes in this population, our work identifies potential targets for interventions to as well as the patients that could benefit from these.
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