STRESS MANAGEMENT FOR PATIENTS WITH HEART-DISEASE - A PILOT-STUDY

Objective: To conduct a feasibility study on stress management for pat ients 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 . Design: Random assignment, two-group clinical trial. Setting: Pacifi c Northwest university-affiliated teaching hospital. Patients: Forty-f ive patients with heart disease (mean age 56 years), who either had a myocardial infarction or coronary bypass surgery. Outcome Measures: Ho stility, subjective distress, resting electrocardiogram, resting blood pressure and blood pressure reactivity to a psychologic stressor, and blood lipid, cortisol, and catecholamine levels. Intervention: Patien ts were randomly assigned to either (1) exercise rehabilitation (ER) a nd an 8-week stress management (SM) program (ER + SM) or (2) ER only. Although the recruitment rate was satisfactory, 67% of patients assign ed to the control condition and 40% of the SM subjects were not availa ble for posttesting. Results: Computed effect sizes indicated that blo od pressure reactivity to a psychologic challenge was reduced after tr eatment in the ER + SM group but not in ER group. The ER + SM group sh owed improvement in perceived health status and had clinically meaning ful reductions in triglyceride levels, whereas the ER group did not. T he ER group had a reduction in high-density lipoproteins, whereas the high-density lipoprotein levels of the ER + SM group did not change. C onclusions: Patients randomly assigned to a control condition may be l ess willing to participate in time-consuming and invasive posttests th an treated patients. Reducing the invasiveness of measurement may incr ease cost-effectiveness and reduce the dropout rate under controlled c onditions. Blood pressure reactivity to a psychologic stress test and changes in serum lipid levels may be sensitive and cost-effective meas ures to include in future studies of cardiac rehabilitation.