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Cardiac patients with optimistic expectations about their recovery were 30 percent less likely to die over the next 15 years than patients with less optimistic expectations, regardless of the severity of their heart disease, according to researchers at Duke University Medical Center.

"This study is unique because it shows that a patient's attitude toward their disease not only impacts their ability to return to a normal lifestyle but also their health over the long term and ultimately their survival," said John C. Barefoot, PhD, the study’s lead author.

The new findings are published in the Archives of Internal Medicine.

Researchers followed heart patients after they had coronary angiography to evaluate blood flow in the heart. While past studies have evaluated how patients' expectations affect their ability to do daily activities, such as work and exercise, Barefoot says the new findings take that research one step further by demonstrating that one's outlook has an effect on physical health and survival.

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.

After 15 years, 1,637 patients had died and 54 percent (885 deaths) were due to cardiovascular disease.

Barefoot says that the higher risk of death remained even after controlling for a range of factors, including the severity of the coronary disease, age, gender, income, depression, social support, and overall functional ability when they were hospitalized.

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

Barefoot says that optimists may more effectively use coping strategies, such as diligently following their treatment plan, which may positively impact their recovery. Another theory is that negative thoughts can lead to tension and stress, which can have damaging effects on the body.

"The take-home message is that having positive expectations can not only make you feel better but also potentially live longer," Barefoot says.

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

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