title: Recovery expectations and long-term prognosis of patients with coronary heart disease.
abstract: BACKGROUND
  Expectations of patients regarding their prospects for recovery have been shown to predict subsequent physical and social functioning. Evidence regarding the impact of expectations on clinical outcomes is limited.
  
  
  METHODS
  At the inpatient service of a tertiary care hospital, we evaluated beliefs of patients undergoing coronary angiography about their prognosis as predictors of long-term survival and 1-year functional status. Baseline assessments, including a measure of expectations for recovery, were obtained during hospitalization with mortality follow-up for approximately 15 years. Patients with significant obstructive coronary artery disease were interviewed while in the hospital and enrolled in follow-up. Functional status was assessed at baseline and 1 year later with questionnaires reflecting physical capabilities. Analyses controlled for age, sex, disease severity, comorbidities, treatments, demographics, depressive symptoms, social support, and functional status. There were 1637 total deaths, 885 from cardiovascular causes, in the 2818 patients in these analyses. The outcomes were total mortality, cardiovascular mortality, and 1-year functional status.
  
  
  RESULTS
  Expectations were positively associated with survival after controlling for background and clinical disease indicators. For a difference equivalent to an interquartile range of expectations, the hazard ratio (HR) for total mortality was 0.76 (95% confidence interval [CI], 0.71-0.82) and 0.76 (95% CI, 0.69-0.83) for cardiovascular mortality. The HRs were 0.83 (95% CI, 0.76-0.91) and 0.79 (95% CI, 0.70-0.89) with further adjustments for demographic and psychosocial covariates. Similar associations (P < .001) were observed for functional status.
  
  
  CONCLUSIONS
  Recovery expectations at baseline were positively associated with long-term survival and functioning in patients with coronary artery disease.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. John.Barefoot@Duke.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Barefoot
authors.forename: Beverly H
authors.initials: BH
authors.lastname: Brummett
authors.forename: Redford B
authors.initials: RB
authors.lastname: Williams
authors.forename: Ilene C
authors.initials: IC
authors.lastname: Siegler
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Helms
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Boyle
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Clapp-Channing
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D003327:Coronary Disease / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D003469:Culture; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012944:Social Support; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome