Heart patients who experienced feelings of hopelessness had an increased risk of dying or suffering a heart attack, according to new University of Liverpool research funded by the British Heart Foundation and presented at the British Cardiovascular Society.
The study reviewed data from 12 studies involving 5,540 patients diagnosed with coronary heart disease, stroke, or heart valve problems and found that feeling hopeless is linked to worse outcomes for heart patients. Having less hope was associated with an increased risk of a first heart attack in people with no previous history of angina, even taking into account other risk factors like age, perceived health status, depression and socioeconomic risk factors.
Researchers noted that in a previous study of men with a pre-existing cardiovascular condition, hopelessness was linked to a six-fold higher risk of death. Even in men who did not have cardiovascular disease, hopelessness still more than doubled the risk of death.
The review showed that more hope was linked to reduced cardiovascular symptoms like angina and post-stroke fatigue.
The authors are now interested in research to understand whether it is possible to boost patients' hope, for example by introducing specialist therapy, or chaplaincy support while in hospital, in case this could help improve health and lower death rates in this at-risk group.
Dr Alexander Montasem, Senior Lecturer in Psychology at the University of Liverpool and author of the study, said: "For many people, living with cardiovascular disease can be a difficult experience. Patients often struggle with debilitating symptoms as well as anxiety about the future. This study aimed to reveal more about how people's outlook on their situation can influence their health.
"Our systematic review suggests that hopelessness could increase people's risk of death, but also their symptoms and how well they stick to treatment plans. Mental health support could be very beneficial for a wide range of people with heart problems."
The researchers, from the University of Liverpool and Lancashire Cardiac Centre, Blackpool Victoria Hospital, reviewed data from 12 studies involving 5,540 patients diagnosed with a number of different cardiovascular diseases. They included studies where levels of hope were assessed using standard questionnaires used to judge a patient's mental state. Three of the studies included data for cardiovascular death or symptoms.
One study found that higher levels of hope protected women against experiencing angina - pain or discomfort in the chest often caused by coronary heart disease. In a study of stroke patients of both sexes, greater hope was strongly linked to reduced levels of post-stroke fatigue.
Six studies included psychological data, which showed that more hope was linked to lower levels of depression and anxiety, and improved resilience and quality of life.
The data also indicate possible reasons for the reduced risk seen in people with more hope, as those with higher hope scores also showed greater levels of self-care and were less likely to skip taking their medications.
Dr Sonya Babu-Narayan, Clinical Director at the British Heart Foundation, said: "This research is a good reminder of how staying hopeful wherever possible can be helpful when it comes to living with cardiovascular disease. It could be an important self-prescription for maintaining your wellbeing and quality of life, alongside your current medical care."
Ruth Goss, Senior Cardiac Nurse at the British Heart Foundation, said: "The review showed that people with hope followed their treatment plans more closely, and it's important to remember that the best thing you can do for your health is to follow the advice recommended by your doctor. Looking after your physical and emotional well-being is important for people living with cardiovascular disease, and if anyone is struggling, they should speak to their medical team."
