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Mar 06, 2018

Optimism Improves Outcomes for Patients with Chronic Chest Pain

Study finds that having a positive outlook could mean fewer hospitalizations for those with chronic angina.

Optimism promotes better outcomes for patients with chronic chest pain, based on a recent study that found that those individuals with a positive outlook on their health had fewer hospital visits and procedures.

This study, which will be presented this week at the American College of Cardiology’s 67th Annual Scientific Session, looked at the association between patient attitudes and health outcomes. It included 2,389 patients with chronic chest pain, also called angina, who were participating in the drug trial, RIVER-PCI. RIVER-PCI tested the effects of ranolazine, which is used to treat heart-related chest pain.

The recent analysis, however, focused on the impact of patient attitudes—rather than the study drug—on patient outcomes.

Upon enrollment, participants were asked how much they agreed or disagreed with the statement, “I am optimistic about my future and returning to a normal lifestyle.” They were then asked the same questions after one, six and twelve months to track any changes in their attitude and quality of life.

After following patients for roughly two years, researchers found that those who were most optimistic were 40% less likely to be hospitalized or have heart procedures compared to those who were least optimistic. Those who were optimistic also had reported fewer angina symptoms overall and were generally healthier than those who were less optimistic. However, optimistic patients were still 30% less likely to be hospitalized or have heart procedures after accounting for these factors.

Many studies have linked depression to increased risk for heart disease—America’s No. 1 killer. This is the first study to show that having hope in one’s future health might be protective for patients with chronic chest pain.

"Feeling better about your disease process and ability to reengage in usual activities may actually make chronic angina easier to deal with," said Alexander Fanaroff, MD, a fellow in the department of cardiology at Duke University Medical Center and the study’s lead author. "Our findings suggest that if we can identify patients who are less optimistic for whatever reason—whether it’s because their disease has made them despair for the future, they have uncertainty about their diagnosis, or they have multiple comorbidities—and help them feel more hopeful by focusing on what they can do, we may be able to positively affect outcomes."

Of course, authors note that additional research is needed to further explore the link between optimism and chest pain. It’s hard to determine whether optimism is a reflection of patients’ health or if it directly affects medical outcomes. Authors encourage future clinical trials to see whether interventions that promote a more positive attitude help improve outcomes.

In the meantime, Fanaroff notes that there is no downside to instilling patients with hope and helping them with self-care. "As a clinician, it doesn’t cost anything to help patients with chronic angina focus on what they can do, letting them know that there are medications and procedures that can help them return to a normal life and continue to do the things they like to do," he said. "Bottom line: there’s reason to be optimistic for patients with chronic angina, and it’s important that clinicians relay that to them."

Questions for You to Consider

  • How is angina treated?

  • Angina can be treated in a variety of ways, including lifestyle changes, medications, and medical procedures. For example, quitting smoking, losing weight and reducing stress can help successfully treat angina in some patients. For others, medications like beta blockers or procedures such as angioplasty and stenting may be necessary to treat the condition.
  • Who is at risk for angina?
  • Those at greatest risk for angina include individuals with heart disease, diabetes, high blood pressure, high cholesterol, or a family history of heart disease. Excess stress, smoking, older age and a lack of exercise can also increase risk for angina. Fortunately, most of these risk factors can be reduced by working with your doctor and making positive lifestyle changes.

Featured Video

Dr. Anne R. Albers, FACC, presents at a Living with Chronic Angina event in Columbus, Ohio in Oct. 2014.

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