Positive Attitude After ACS Translates Into Fewer Hospital Readmissions at 6 Months

Patients who report feeling optimistic shortly after experiencing ACS are more physically active and have fewer cardiac readmissions at 6 months, a new study suggests. The same benefits do not extend to patients who say they feel gratitude, researchers reported online today in Circulation: Cardiovascular Quality and Outcomes.

According to investigator Jeff C. Huffman, MD, a psychiatrist at Massachusetts General Hospital (Boston, MA), “these relationships were above and beyond traditional predictors of health, recovery, and readmissions.” Moreover, the fact that optimism was tied to activity apart from other baseline factors suggests that “there seems to be something distinct and important going on here,” he told TCTMD in an email.

But the findings must be replicated in a larger, longer-term study, he stressed, adding, “[W]e don’t yet know if actively cultivating optimism is possible and, if it is possible, whether that improves heart health.”

For the single-center GRACE (Gratitude Research in Acute Coronary Events) study, Huffman and colleagues studied 164 patients (mean age 61.5 years; 84% men) who underwent baseline assessment at 2 weeks after being hospitalized for ACS. Among them, 156 completed 6-month follow-up.

Optimism—measured using the 6-item Life Orientation Test-Revised—was linked to a higher mean number of daily steps (β = 102.5; 95% CI 13.6-191.5; P= .024) and a lower risk of nonelective cardiac readmission at 6 months (HR 0.92; 95% CI 0.86-0.98; P = .006), even when results were adjusted for baseline activity, sociodemographic and medical factors, and comorbid depression and anxiety. However, optimism did not influence 6-month levels of cardiac biomarkers including high-sensitivity C-reactive protein and NT-proBNP, among others.

Gratitude—assessed via the Gratitude Questionnaire-6—appeared to have no effect on 6-month outcomes.

Patients Take Their Cue From Cardiologists

“Stress and depression in heart patients have long been a big focus in cardiology, but … boosting optimism may be just as important in thriving after a major heart event,” Huffman noted.

Cardiologists “have been surprisingly receptive,” to this vein of research, he said. “In my experience, cardiologists are aware of the role that stress and mood play in their patients’ health, and [they] have been interested in research that sort of flips this concept on its head by examining the effects of positive thoughts and feelings rather than just focusing on ‘removing’ stress or sadness.”

Huffman noted that patients often “take their cue from their cardiologists in terms of how hopeful they are allowed to feel.”

The topic needs to be framed appropriately, along the lines of: “This heart attack is not the end of your life [but] the beginning of a new life, where you are taking better care of yourself and making your health a priority, and when people do this, they really thrive.”

This approach sends 2 messages, Huffman explained. First, it makes people feel hopeful, playing an active role in their recovery and second, that by “staying motivated, committed, and consistent, they can make real changes in their health and prognosis.”

As the researchers note in their paper, not all psychological states carry the same weight. Optimism, they say, “focuses on future expectations” and is “more action-based—a sense that one can do something to reach a goal—which may promote beneficial changes in health behavior.” By contrast, gratitude involves people having feelings of “well-being by taking stock of their immediate and previous experiences.”

Furthermore, it remains to be seen whether specific strategies can be used to promote optimism in patients with cardiovascular disease and whether these interventions would actually improve clinical outcomes, they conclude.

Source: 
Huffman JC, Beale EE, Celano CM, et al. Effects of optimism and gratitude on physical activity, biomarkers, and readmissions after an acute coronary syndrome: the Gratitude Research in Acute Coronary Events study. Circ Cardiovasc Qual Outcomes. 2015;Epub ahead of print.

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