Stress management for patients with heart disease: a pilot study

To conduct a feasibility study on stress management for patients with heart disease; more specifically, to test the availability of patients, determine dropout rates, and investigate the sensitivity to change of a large number of psychologic and biologic stress indexes.

Random assignment, two-group clinical trial.

Pacific Northwest university-affiliated teaching hospital.

Forty-five patients with heart disease (mean age 56 years), who either had a myocardial infarction or coronary bypass surgery.

Hostility, subjective distress, resting electrocardiogram, resting blood pressure and blood pressure reactivity to a psychologic stressor, and blood lipid, cortisol, and catecholamine levels.

Patients were randomly assigned to either (1) exercise rehabilitation (ER) and an 8-week stress management (SM) program (ER + SM) or (2) ER only. Although the recruitment rate was satisfactory, 67% of patients assigned to the control condition and 40% of the SM subjects were not available for posttesting.

Computed effect sizes indicated that blood pressure reactivity to a psychologic challenge was reduced after treatment in the ER + SM group but not in ER group. The ER + SM group showed improvement in perceived health status and had clinically meaningful reductions in triglyceride levels, whereas the ER group did not. The ER group had a reduction in high-density lipoproteins, whereas the high-density lipoprotein levels of the ER + SM group did not change.

Patients randomly assigned to a control condition may be less willing to participate in time-consuming and invasive posttests than treated patients. Reducing the invasiveness of measurement may increase cost-effectiveness and reduce the dropout rate under controlled conditions. Blood pressure reactivity to a psychologic stress test and changes in serum lipid levels may be sensitive and cost-effective measures to include in future studies of cardiac rehabilitation.