Recovery expectations for patients with CAD reflect long-term survival

**Barefoot J. Arch Intern Med. 2011;doi:10.1001/archinternmed.2011.41.**

Issue: April 2011

The baseline recovery expectations of patients with coronary artery disease were shown to positively correlate with long-term survival and functioning in a new study.

Researchers from Duke University Medical Center and Duke Clinical Research Institute, Durham, N.C., enrolled patients (n=2,818) who underwent diagnostic coronary angiography at the medical center from 1992 to 1996. All patients were found to have clinically significant CAD (>75% diameter stenosis of >1 coronary artery).

At the 15-year follow-up, 1,637 deaths were reported, 885 of which were from CV causes. CABG was performed at some point during this period on 1,277 participants (45.3%), and percutaneous transluminal coronary angioplasty was performed on 1,156 participants (41%), whereas those who were not treated with one or both procedures received medical treatment (n=781; 27.7%).

Overall, expectations were positively associated with survival regarding total mortality (HR=0.76; 95% CI, 0.71-0.82) and CV mortality (HR=0.76; 95% CI, 0.69-0.83). After further adjustments for demographic and psychosocial covariates, the relationships remained but to a lesser extent for both total mortality (HR= 0.83; 95% CI, 0.76-0.91) and CV mortality (HR=0.79; 95% CI, 0.70-0.89). Similar associations (P<.001) were also found regarding functional status.

As potential mechanisms for explaining the observed benefits, the researchers said the predisposition of optimists makes their coping more effective in reducing risk factor levels and improving levels of life satisfaction, whereas pessimists tend to experience more tension and negative emotions during recovery, thereby heightening stress reactions.

These study’s findings, they wrote, “argue for expanded efforts to understand the influence of recovery expectations and the potential benefits of attempts to modify them. The potential feasibility of altering specific aspects of patient beliefs provides a promising avenue for intervention if the importance of expectations is confirmed.”

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