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Positive Expectations About Recovery May Increase Survival in People With Coronary Artery Disease
By Courtney Ware
WebMD Health News
Reviewed by Laura J. Martin, MD
Feb. 28, 2011 -- "Your attitude affects your latitude" may be more than a cliche, a new study suggests.
Hospitalized patients diagnosed with coronary artery disease who had a positive outlook about their recovery were less likely to die over the next 15 years and had better physical functioning after one year, according to a new study.
Previous studies have found that heart patients' optimism and expectations have positively influenced their functional status and return to work. But researchers say this study takes it a step further by showing how patient beliefs affect their health over the long term and ultimate survival.
The findings are published in the Archives of Internal Medicine.
Positive Outlook, Longer Survival
Researchers at Duke University Medical Center followed 2,818 heart patients after they had coronary angiography to evaluate blood flow in the coronary arteries of the heart. They measured how patient expectations affected their recovery and ability to perform normal physical activities.
Patients completed a questionnaire about their future lifestyle (e.g. "My heart condition will have little or no effect on my ability to do work," "I expect that my lifestyle will suffer because of my heart condition") and their future outcome (e.g. "I can still live a long and healthy life," "I doubt that I will ever fully recover from my heart problems").
Study author John C. Barefoot, PhD, and his team took into account such factors as disease severity and health history, depressive symptoms, social support, age, sex, education, and income. Independent of these factors, the death rate of patients with the highest expectations was 31.8 deaths per 100 patients, compared to those with the lowest expectations at 46.2 deaths per 100 patients.
The patients with optimistic expectations had an associated 17% decrease in their likelihood of dying over the 15-year study period.
"We know there is a relationship between depression and increased rates of mortality," Barefoot says in a statement. "These findings demonstrate the magnitude of the impact of patient expectations on the recovery process above and beyond depression and other psychological or social factors."
Explaining the Effects of Expectations
Barefoot and colleagues give two possible reasons for these observed effects of expectations. One is the optimists' coping strategy -- they may more diligently follow their treatment plan, rather than withdrawing or focusing on the emotional consequences -- which may positively affect their recovery.
Another explanation is that negative expectations may lead to stress and tension, which can have damaging effects on the body and increase the patient's risk of cardiac events.
Hope and Realism
In an editorial, Robert Gramling, MD, and Ronald Epstein, MD, who are affiliated with the University of Rochester, encourage doctors to consider emotions as well as data when approaching the message of optimism versus pessimism with patients. They say such an approach builds on the notion that "hope is complementary to, and not in direct conflict with," reality and "affirms the importance of both."
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