How to life

Optimistic Heart Patients Live Longer

Heart patients who were optimistic about their treatment and recovery were more likely to be alive after 15 years than patients with similar disease but lower expectations, new research shows.

Researchers at Duke University Medical Center tracked the psychological and physical health of more than 2,800 patients who had undergone coronary angiography, a procedure used to monitor blood flow to the heart. The patients, all of whom had been diagnosed with heart disease, were given an 18-item questionnaire to assess how much or little optimism they felt about their diagnosis and recovery.

Patients with more optimism, for example, might agree with the statement “My heart condition will have little effect on my ability to work.’’ A less optimistic patient might be more likely to agree with the statement “I doubt I will ever fully recover from my heart problems.’’

Over the next 15 years, more than 1,600 of the study patients had died, and about half the deaths were related to heart disease. The researchers found that optimism was a strong predictor of overall survival. Patients who scored low on optimism tests were 30 percent more likely to die during the study period, even after the researchers controlled for factors like depression and severity of disease.

The results were the same whether the researchers compared death by all causes or just death caused by heart disease. The findings were were published Monday in the The Archives of Internal Medicine.

The study’s lead author, John C. Barefoot, professor emeritus in the department of psychiatry at Duke, said the findings are important because they show that a patient’s attitude about an illness is not only associated with short-term recovery but overall health over the long term. The researchers noted that the level of optimism displayed by patients didn’t have to be extreme to have an effect. The benefit of optimism was calculated by comparing moderately optimistic patients, who scored in the 75th percentile, to moderately pessimistic patients, who were in the 25th percentile of scoring.

“It’s not unrealistic, unbridled optimism,” said Dr. Barefoot. “You’ve got to temper your optimisms with some realism, but you can have both.”

Dr. Barefoot said the benefit of optimism may be that an optimistic patient is more likely to pay attention to doctors, take medicine regularly and adopt long-term lifestyle changes, compared with a pessimistic patient. Or it may be that optimism helps patients better manage stress and avoid the health consequences associated with stress and worry.

“If you get depressed and feel a lot of stress and worry, then that exacerbates your problems,’’ said Dr. Barefoot. “Looking at these patients, the impression I get is that they are determined. They are thinking positively about getting things done.’’

In an accompanying editorial, Dr. Robert Gramling and Dr. Ronald Epstein said the findings suggest more research is needed into the effect of optimism on health.

“The degrees of benefit observed in these studies suggest that optimism is a powerful drug that compares favorably with highly effective medical therapies,’’ the doctors wrote. “Given the magnitude of effect that optimism has on heart heath and survival, more research is needed to unveil the pathways underlying this phenomenon.”

Dr. Barefoot noted that the next step for researchers is to determine whether simple interventions aimed at boosting optimism in patients can make a meaningful difference in long-term health.

“There are a couple of promising studies out there that show you can do relatively brief counseling in the hospital with people and have a positive effect at least on their ability to return to work and function normally when they get out of the hospital,” said Dr. Barefoot. “Whether that will translate into longevity after treatment we don’t know, but we ought to try and find out.”

February 28, 2011
NY Times
By Tara Parker-Pope