Optimistic outlook linked to positive CAD outcomes
MedWire News: US researchers report that the recovery expectations of coronary artery disease (CAD) patients may significantly influence their long-term outcomes.
"Patients with CAD who had more favourable 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," say John Barefoot (Duke University Medical Center, Durham, North Carolina) and colleagues.
They explain: "Recovery expectations are linked to levels of negative affect, which has prevalence in patients with cardiac disease, and has been shown to predict early mortality."
Barefoot and team assessed the beliefs and physical function of 2818 CAD patients by questionnaire at baseline. The level of physical functioning of all patients was reassessed at the end of a 15-year follow-up period.
Patient beliefs were evaluated using the 18-question Expectations for Coping Scale (ECS; possible score of 0 to 90), and physical function was determined via the 12-question Duke Activity Status Index (DASI) (possible score of 0.0 to 58.2)
The patients had mean baseline ECS and DASI scores of 63.0 and 18.8, respectively, and by study-end, the group's mean DASI score increased by 2.9 points, reflecting an overall improvement in the group's level of physical functioning.
Barefoot et al report in the Archives of Internal Medicine that over the follow-up period, 1637 deaths occurred, with 885 (54%) due to cardiovascular (CV) causes.
After adjusting for differing baseline characteristics, and categorizing patients into quartiles according to their ECS scores, Barefoot and colleagues found that fewer patients in the highest quartile for positive expectations died compared with those in the lowest quartile, at 31.8 versus 46.2 per 100 patients.
This translated to respective risk reductions of 17% and 21% for total and CV mortality, among patients with the highest compared with the lowest ECS scores (p<0.001).
Overall, patients' baseline ECS scores were also found to correlate positively with their level of physical functioning at follow-up, in that patients in the highest ECS score quartile had 4.7-fold higher DASI scores than those in lowest ESC score quartile (p<0.001).
Barefoot and team conclude: "The potential feasibility of altering specific aspects of patient beliefs provides a promising avenue for intervention if the importance of expectations is confirmed."
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By Lauretta Ihonor