Lower Risk of Death Linked to Optimism in Heart Patients

If newly diagnosed heart disease patients who must undergo treatment are optimistic, and expect they'll resume normal activities, do they actually do better than if they're pessimistic about the outcome? 

Reporting on their 15-year study in this week's Archives of Internal Medicine, Duke University Medical Center researcherssay they do, raising the issue of whether physicians should go out of their way to accentuate the positive.

"Patients with coronary artery disease who had more favorable expectations about their likelihood of recovery and return to a normal lifestyle had better long-term survival as well as better functional status after their hospitalization," concluded John C. Barefoot and colleagues in the Outcomes Research Group and the Duke Division of Cardiology.

The mortality rate for those in the highest quartile of expectations, that is the most optimistic, was 28.8 deaths per 100 patients during the 10 years after baseline, compared with 56.9 deaths per 100 for those in the lowest quartile.

In a related commentary, Robert Gramling, MD and Ronald Epstein, MD, of the University of Rochester in New York wrote that indeed, "optimism is a powerful 'drug' that compares favorably with highly effective medical therapies" because optimism facilitates contemplation and decision making.

They said the study might prompt physicians to promote the positive when they have to give bad diagnostic news. They might, for example, say "...but I think you'll beat the odds."

Barefoot's study used "extensive controls for clinical disease indicators" as well as a variety of adjustments for psychosocial variables such as depression.