Association of perceived stress with health status outcomes in patients with peripheral artery disease

Abstract

Objective: To assess association of chronic self-perceived stress with health status outcomes of patients with peripheral artery disease.

Methods: The PORTRAIT study is a prospective registry that enrolled 1275 patients with symptoms of peripheral artery disease across 16-sites in US, Netherlands, and Australia from June 2011 to December 2015. Demographics, comorbidities and diagnostic information was abstracted from chart review. Self-perceived stress was assessed using the 4-item perceived stress scale at baseline, 3- and 6-month follow-up. Scores range from 0 to 16 with higher scores indicating greater stress. Sum scores were calculated at each time point and averaged to quantify average exposure to stress from enrollment through 6 months. Disease-specific health status were assessed at baseline and 12-months using the peripheral artery disease questionnaire summary score.

Results: The mean age of the analytical cohort (n = 1060) was 67.7 ± 9.3 years, 37.1% were females, and 82.3% were white. Comorbidities were highly prevalent with 80.9% having hypertension, 32.6% having diabetes, and 36.4% being smokers. In models adjusted for demographics, comorbidities, disease severity and socioeconomic status, having a higher average stress score was associated with poorer recovery (from baseline) in peripheral artery disease questionnaire summary score at 12-months (-1.4 points per +1-point increase in averaged 4-point perceived stress score, 95% CI -2.1, -0.6 p < 0.001).

Conclusion: In patients with peripheral artery disease, experiencing higher chronic stress throughout the 6-months following their diagnosis, was independently associated with poorer recovery in 12-month disease-specific health status outcomes. (ClinicalTrial.gov identifier: NCT01419080).

Keywords: Chronic stress; Health status; Peripheral artery disease.

Copyright © 2020 Elsevier Inc. All rights reserved.

Figures

Figure 1.

STROBE diagram showing selection process for final study cohort.

Figure 2.

Generic and disease-specific health status at baseline, 3-, 6- and 12-month follow-up in patients with high and low chronic stress. (disease specific health status assessed by Peripheral Artery Disease Questionairre Summary Score and generic health status examined by Euro-Quality of Life Visual Analog Scale) [PAQ= Peripheral Artery Disease Questionnaire]

Figure 3.

Association of a single point increase in averaged PSS-4 with corresponding change in PAQ SS (baseline to 12-months) in patients with peripheral artery disease. [PSS-4= 4-point Perceived Stress Scale, PAQ= Peripheral Artery Disease Questionnaire]

Figure 4.

Association of a single point increase in averaged PSS-4 with corresponding change in (baseline to 12-months) EuroQoL Visual Analog Scale in patients with PAD. [PSS-4= 4-point Perceived Stress Scale]