Optimistic Outlook Associated With Better Outcome in Chronic Angina

MedicalResearch.com Interview with:

Dr. Alexander Fanaroff, Duke

Dr. Fanaroff

Dr. Alexander Fanaroff MD
Duke University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Among patients with chronic angina, there are strong associations between depression and clinical outcomes, which illustrates the important interplay between psychosocial symptoms and physical symptoms in this condition. But depressive symptoms are distinct from expectations and optimism regarding recovery and returning to a one’s normal lifestyle. Patients with chronic angina may not be optimistic about their outlook for a number of reasons, including uncertainty about their prognosis or lack of medical knowledge, but for many patients with chronic angina, the outlook is actually quite good.

We examined data from RIVER-PCI, a clinical trial that randomized patients with chronic angina and incomplete revascularization to ranolazine or placebo, and were followed for the primary outcome of ischemia-driven hospitalization or revascularization. Patients were asked at baseline, 1 month, 6 months, and 12 months how much they agreed with the phrase, “I am optimistic about my future and returning to a normal lifestyle.” We categorized patients by their responses at baseline – we coded “strongly agree” as very optimistic, “agree” as optimistic, “neutral” as neutral, and “disagree” and “strongly disagree” as not optimistic – and evaluated the association between baseline optimism and the primary outcome over long-term follow-up.

We found that most patients were optimistic at baseline – 33% were very optimistic, 42% were optimistic, 19% were neutral, and 5% were not optimistic – and the majority remained optimistic over long-term follow-up. The most optimistic patients had a lower prevalence of prior myocardial infarction, heart failure, diabetes, and chronic kidney disease and less severe angina at baseline than less optimistic patients. The rate of the ischemia-driven hospitalization or revascularization was higher in neutral (32.8%) and not optimistic (35.0%) patients compared with the most optimistic patients (24.4%). Even after adjusting for baseline comorbidities and angina frequency, the most optimistic patients had a 30% lower risk of ischemia-driven hospitalization or revascularization compared with neutral or not optimistic patients.

MedicalResearch.com: What should readers take away from your report?

Response: The association between self-reported optimism and better outcomes suggests an important role for health outlook and coping in angina patients. In any observational study, we can never be certain whether the association we see is causal (or which direction the causality runs); in this study, low expectations for recovery may be a marker of bad outcomes (meaning patients assess their situation accurately) rather than a modifiable target for intervention. Regardless, there is no harm in attempting to help patients with chronic angina feel more optimistic. Providers should assess uncertainty about the future in chronic angina patients expressing low optimism, and reassure them about their prognosis. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: There are a number of interventions that can improve patients’ expectations and beliefs about illness, which have proven effective in patients with myocardial infarctions. A randomized controlled trial of this type of intervention in patients with chronic angina should be undertaken.

No disclosures


ACC 2018 March 10 2018

Association Between Optimism and Outcomes in Patients with Chronic Angina
Alexander C. FanaroffKristi PratherDaniel WojdylaOri Ben-YehudaGiora WeiszGregg StoneBruce KochErik Ohman and Karen Alexander
Journal of the American College of Cardiology
Volume 71, Issue 11 Supplement, March 2018
DOI: 10.1016/S0735-1097(18)30632-6

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