By Duke Medicine News and Communications

Baltimore, Maryland – Cardiac patients who have pessimistic beliefs about their recovery are twice as likely to die early than those who feel more optimistic, according to researchers at Duke University Medical Center.

"This study is one of the first to examine how a patient's attitude toward their disease impacts their health over the long term -- and ultimately their survival," said Dr. John C. Barefoot, who presented the findings at the American Psychosomatic Society Annual Meeting.

Barefoot explained that past studies have looked at how patient's expectations impact their ability to engage in daily activities, like returning to work and exercising. The new findings take that research one step further by demonstrating that one's outlook has an impact on physical health.

More than 2,800 patients with coronary disease were given a psychological questionnaire and asked to evaluate their expectations about their ability to recover from the illness and return to a regular routine. Study participants included those with at least one blocked artery.

In 2002, six to 10 years after the patients were enrolled in the study, 978 patients had died. Of those deaths, 66 percent were due to their coronary disease.

Barefoot explained that the higher risk of death remained consistent despite a range of factors, including the severity of the coronary disease, age, gender, income, depressive symptoms and the ability to complete routine tasks at the time of hospitalization.

"We already know that there is a relationship between depression and increased rates of mortality," Barefoot said. "These findings demonstrate the magnitude of the impact of patient expectations on the recovery process regardless of other psychological or social factors," Barefoot said.

Barefoot explained that the study results provide important insight for both physicians and patients.

"The take-home message for practitioners is that they need to consider the role of their patient's beliefs as part of the recovery process. For patients, this means that having positive expectations can not only make you feel better but also potentially live longer," he said.

Further research will be needed to determine how positive expectations affect disease survival. The researchers speculate that coping behaviors, such as following a doctor's treatment plan, may contribute to an improved recovery. Another theory is that positive thoughts may lessen the damaging effects of stress on the body.

This research was supported by grants from the National Heart, Lung, and Blood Institute.

Co-authors on the study include Beverly H. Brummett, Nancy Clapp-Channing, Redford B. Williams, Ilene C. Siegler and Daniel B. Mark of Duke University Medical Center.