Prognostic Importance of Emotional Support for Elderly Patients Hospitalized With Heart Failure

Krumholz, Harlan M.; Butler, Javed; Miller, Jeremy B; Vaccarino, Viola; Williams, Christianna S.; Leon, Carlos F. Mendes de; Seeman, Teresa E.; Kasl, Stanislav V.; Berkman, Lisa F.

doi:10.1161/01.cir.97.10.958

Cited by 310 publications

(227 citation statements)

References 28 publications

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“…99 Table 5 lists 11 studies evaluating the relationship between social factors and prognosis in patients with preexisting CAD. [113][114][115][116][117][118][119][120][121][122][123] Significant prognostic relationships are present in most of these studies, and the risk ratios are substantial. For instance, Berkman et al 119 observed a nearly 3-fold increase in subsequent cardiac events in post-MI patients reporting a low level of emotional support, and Williams et al 118 observed a similar 3-fold increase in mortality over 5 years among CAD patients who were unmarried or had no significant confidant in their life.…”

Section: Social Isolation and Lack Of Social Supportmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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Abstract-Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis.Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys.Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. ...

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Section: Social Isolation and Lack Of Social Supportmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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“…Kaplan et al, 1994;Orth-Gomer, Rosengren, & Wilhelmsen, 1993;Pennix et al, 1997;Seeman et al, 1993;Vogt, Mullooly, Ernst, Pope, & Hollis, 1992). Social isolation is particularly unhealthy in patients with preexisting CHD (Angerer et al, 2000;Berkman, Leo-Summers, & Horwitz, 1992;Case, Moss, Case, McDermott, & Eberly, 1992;Gorkin et al, 1993;Horsten et al, 2000;Krumholz et al, 1998;Welin, Lappas, & Wilhelmsen, 2000;R. B. Williams et al, 1992;Woloshin et al, 1997), although different indicators of support and isolation sometimes produce inconsistent effects (Irvine et al, 1999).…”

Section: Social Isolation and Conflictmentioning

confidence: 99%

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Smith¹,

Ruiz²

2002

Journal of Consulting and Clinical Psychology

292

208

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Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research.Coronary heart disease (CHD) is the leading cause of death in the United States; each year about 450,000 people die from CHD, and 1,000,000 experience an initial or recurrent coronary event (American Heart Association, 2001). Among healthy 40-year olds, between 40% and 50% of men and between 25% and 35% of women will later develop CHD (Lloyd-Jones, Larson, Beiser, & Levy, 1999). Over $100 billion is spent on CHD each year in the United States in direct medical costs, disability payments, and lost productivity (American Heart Association, 2001). This disease involves the three major topics composing behavioral medicine and health psychology, making it a central focus throughout their 30-year history. In the first (i.e., health behavior and prevention), modifiable behavioral risk factors (e.g., smoking, activity level, diet) are important risk factors for the development of CHD (Stamler et al., 1999;Wannamethee, Shaper, Walker, & Ebrahim, 1998), and behavior change is an essential component of prevention. In the second topic (i.e., stress and disease or psychosomatics), other psychological and social factors have more direct effects on the development and course of CHD through the intervening psychobiological effects of stress and negative emotions. In the third (i.e., psychosocial aspects of medical illness and care), established CHD has extensive emotional and social impacts on patients and their families, behavior is a key element of standard care (e.g., medication adherence, dietary change, exercise), and psychosocial interventions are useful additions to traditional medical and surgical treatment.Like the article on CHD in the previous special issue on behavioral medicine in this journal (Thoresen & Powell, 1992), we focused primarily on the second major topic-psychosocial influences on the development and course of CHD. We also reviewed one aspect of the third topic-interventions targeting psychosocial risk factors and their underlying psychophysiological mechanisms. Perhaps the most important implication of research on psychosocial risk factors for coronary disease is that interventions targeting these factors could reduce cardiac morb...

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“…Although the direction of causation underlying this correlation remains somewhat controversial, it seems quite likely that health is an important determinant of subjective well-being. In turn, a large and growing literature suggests that physical health itself is strongly conditioned by social factors, so it is plausible to conjecture that health constitutes one pathway through which social factors influence subjective well-being (Berkman & Glass 2000;House et al 1982;Reed et al 1983;Schoenbach et al 1986;Seeman et al 1993;Sugisawa et al 1994;Farmer & Stucky-Ropp 1996;Kessler & Essex 1997;Roberts et al 1997;Krumholz et al 1998;Kawachi & Berkman 2000;Kawachi & Kennedy 1997;Ryff & Singer 2003). Although not exploring directly the putative impact of health on subjective well-being, our analysis here does include self-reports on physical health, as a way of estimating the possible indirect effects of social factors on subjective well-being.…”

Section: Introductionmentioning

confidence: 99%

* The social context of well-being

Helliwell¹,

Putnam²

2005

The Science of Well-Being

538

638

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Large samples of data from the World Values Survey, the US Benchmark Survey and a comparable Canadian survey are used to estimate equations designed to explore the social context of subjective evaluations of well-being, of happiness, and of health. Social capital, as measured by the strength of family, neighbourhood, religious and community ties, is found to support both physical health and subjective well-being.Our new evidence confirms that social capital is strongly linked to subjective well-being through many independent channels and in several different forms. Marriage and family, ties to friends and neighbours, workplace ties, civic engagement (both individually and collectively), trustworthiness and trust: all appear independently and robustly related to happiness and life satisfaction, both directly and through their impact on health.

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Prognostic Importance of Emotional Support for Elderly Patients Hospitalized With Heart Failure

Cited by 310 publications

References 28 publications

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

* The social context of well-being

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