Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure.
BACKGROUND
Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF.


METHODS
All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program.


METHODS
Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1).


RESULTS
Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20).


CONCLUSIONS
Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.
von Känel
Roland
R
Cardiovascular Prevention and Rehabilitation, Bern University Hospital, Inselspital, University of Bern, Switzerland. roland.vonkaenel@insel.ch
Saner
Hugo
H
Kohls
Sonja
S
Barth
Jürgen
J
Znoj
Hansjörg
H
Saner
Gaby
G
Schmid
Jean-Paul
JP
D000368:Aged; D001007:Anxiety / Q000503:physiopathology / Q000523:psychology; D002908:Chronic Disease; D003863:Depression / Q000503:physiopathology / Q000523:psychology; D004644:Emotions; D015444:Exercise; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000523:psychology* / Q000534:rehabilitation; D006339:Heart Rate; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D020127:Recovery of Function; D013315:Stress, Psychological / Q000209:etiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D014630:Vagus Nerve / Q000503:physiopathology