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Positive outlook benefits patients with chronic angina
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ORLANDO, Fla. — Among patients with chronic angina, those displaying the highest level of optimism at baseline had reduced risk for ischemia-driven revascularization and hospitalization, according to findings presented at an American College of Cardiology web briefing.
Alexander C. Fanaroff, MD, chief fellow at Duke Clinical Research Institute and fellow in cardiovascular medicine at Duke University, and colleagues analyzed 2,389 patients with chronic angina from the RIVER-PCI study of the effect of ranolazine (Ranexa, Gilead) on ischemia-driven revascularization and hospitalization.
“Chronic angina afflicts 8.7 million people in the United States and contributes to lower quality of life and higher rates of health care utilization,” Fanaroff said during the briefing. “Among these patients, there are strong associations between depression and clinical outcomes. But depressive symptoms only partially comprise the spectrum of psychosocial illness and are distinct from expectations regarding recovery or optimism. We wanted to look at the association between baseline optimism and clinical outcomes.”
Each patient was asked at baseline, 1, 6 and 12 months how much they agreed with the phrase, “I am optimistic about my future and returning to a normal lifestyle.”
Patients were stratified by the degree of which they agreed with the statement. At baseline, 33.2% strongly agreed, 42.4% agreed, 19.1% were undecided and 5.2% said they disagreed or strongly disagreed.
During a median follow-up of 643 days, the rate of ischemia-driven revascularization and hospitalization was lower in the most optimistic patients (24.4%) compared with undecided (32.8%) and not optimistic patients (35%), according to the researchers.
In risk-adjusted models with the most optimistic group as the reference, the undecided group had increased risk for ischemia-driven revascularization or hospitalization (aHR = 1.42; 95% CI, 1.14-1.77) and the not optimistic group had a trend toward increased risk (aHR = 1.38; 95% CI, 0.98-1.94), they found.
“The association between self-reported optimism and better outcomes suggests an important role for health outlook and coping in angina patients,” Fanaroff said during the briefing. “There have been a number of clinical trials in conditions other than chronic angina, which have shown that brief interventions can change patients’ illness beliefs and expectations. Based on the results of our study, we would suggest that randomized controlled trials of these interventions should be undertaken in patients with chronic angina. For now, though, there really is no harm in trying to make patients more optimistic and have better expectations for their recovery. Providers should assess patients’ understanding of heart disease and angina and reassure those with low optimism about the likelihood of recovery.” – by Erik Swain
Reference:
Fanaroff AC, et al. Abstract 1171-442. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.
Disclosure: Fanaroff reports no relevant financial disclosures.