Positivity could be key to better outcomes for those with chest pain

The mind-body connection includes a concept that our thoughts, feelings and beliefs can impact our physical health. Could those suffering from chronic angina improve outcomes by changing their outlook? A new study to be presented at the American College of Cardiology’s 67th Annual Scientific Session suggests so.

“Feeling better about your disease process and ability to reengage in usual activities may actually make chronic angina easier to deal with,” wrote lead author Alexander Fanaroff, MD, with Duke University Medical Center, and colleagues. “Our findings suggest that if we can identify patients who are less optimistic for whatever reason—whether it’s because their disease has made them despair for the future, they have uncertainty about their diagnosis, or they have multiple comorbidities—and help them feel more hopeful by focusing on what they can do, we may be able to positively affect outcomes.”

In the study, researchers sought to determine if individuals with chronic chest pain, who were self-described as being optimistic about their disease and future health, had fewer episodes of heart-related hospital stays or revascularization procedures.

The researchers reviewed data from approximately 2,400 people exhibited chronic angina, underwent percutaneous coronary intervention (PCI) and enrolled in the RIVER-PCI trial. The trial tested if taking ranolazine to treat chest pain, in combination with usual care, would reduce hospital stays and revascularization procedures.

As part of the RIVER-PCI trial, patients were asked to complete a questionnaire as part of the trial regarding their quality of life, frequency of angina and level of agreement with the statement, “I am optimistic about my future and returning to a normal lifestyle.” The questions were asked at one, six and 12 months.

Using data from the RIVER-PCI trial, the researchers categorized and grouped patients based on their level of optimism at the start of the RIVER-PCI trial, irrespective of treatment received. This was meant to gauge how impactful their optimism was on hospitalizations and revascularizations during follow up.

Of the patients surveyed:

• 33 percent were “most optimistic” or “strongly agreed.”
• 42 percent were “somewhat optimistic” or “agreed.”
• 19 percent were “undecided.”
• Five percent were not optimistic or “disagreed” or “strongly disagreed.”

Results showed the patients who were the more optimistic were 40 percent less likely to be hospitalized with angina or have a revascularization procedure. Additionally, researchers noted that the most optimistic group were also healthier overall, but they were still 30 percent less likely to go to the hospital or have a revascularization procedure in spite of the health fact.

The results also found the rate of the primary outcome in the “undecided” and “not optimistic” patients were approximately 33 and 35 percent, respectively, compared with the “most optimistic” patients at 24 percent.

While it is still unclear whether less optimistic patients feel that way because of uncertainty about the future, clinicians can guide them with treatment plans and help them return to a normal life. Testing strategies that might encourage a patient to be more positive regarding their disease may be a logical next step.