title: Effects of Optimism and Gratitude on Physical Activity, Biomarkers, and Readmissions After an Acute Coronary Syndrome: The Gratitude Research in Acute Coronary Events Study.
abstract: BACKGROUND
  Positive psychological constructs, such as optimism, are associated with beneficial health outcomes. However, no study has separately examined the effects of multiple positive psychological constructs on behavioral, biological, and clinical outcomes after an acute coronary syndrome (ACS). Accordingly, we aimed to investigate associations of baseline optimism and gratitude with subsequent physical activity, prognostic biomarkers, and cardiac rehospitalizations in post-ACS patients.
  
  
  RESULTS
  Participants were enrolled during admission for ACS and underwent assessments at baseline (2 weeks post-ACS) and follow-up (6 months later). Associations between baseline positive psychological constructs and subsequent physical activity/biomarkers were analyzed using multivariable linear regression. Associations between baseline positive constructs and 6-month rehospitalizations were assessed via multivariable Cox regression. Overall, 164 participants enrolled and completed the baseline 2-week assessments. Baseline optimism was significantly associated with greater physical activity at 6 months (n=153; β=102.5; 95% confidence interval, 13.6-191.5; P=0.024), controlling for baseline activity and sociodemographic, medical, and negative psychological covariates. Baseline optimism was also associated with lower rates of cardiac readmissions at 6 months (n=164), controlling for age, sex, and medical comorbidity (hazard ratio, 0.92; 95% confidence interval, [0.86-0.98]; P=0.006). There were no significant relationships between optimism and biomarkers. Gratitude was minimally associated with post-ACS outcomes.
  
  
  CONCLUSIONS
  Post-ACS optimism, but not gratitude, was prospectively and independently associated with superior physical activity and fewer cardiac readmissions. Whether interventions that target optimism can successfully increase optimism or improve cardiovascular outcomes in post-ACS patients is not yet known, but can be tested in future studies.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01709669.
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.). jhuffman@partners.org.
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Eleanor E
authors.initials: EE
authors.lastname: Beale
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Celano
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Scott R
authors.initials: SR
authors.lastname: Beach
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Arianna M
authors.initials: AM
authors.lastname: Belcher
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Shannon V
authors.initials: SV
authors.lastname: Moore
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Laura
authors.initials: L
authors.lastname: Suarez
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Shweta R
authors.initials: SR
authors.lastname: Motiwala
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Parul U
authors.initials: PU
authors.lastname: Gandhi
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.affiliation: From the Harvard Medical School, Boston, MA (J.C.H., C.M.C., S.R.B., L.S., S.R.M., P.U.G., H.K.G., J.L.J.); Department of Psychiatry (J.C.H., E.E.B., C.M.C., S.R.B., S.V.M., L.S.) and Division of Cardiology, Department of Medicine (A.M.B., P.U.G., H.G., J.L.J.), Massachusetts General Hospital, Boston; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.R.M.).
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology* / Q000628:therapy*; D001294:Attitude to Health; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D000067656:Optimism; D010359:Patient Readmission; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers
keywords: acute coronary syndrome; comorbidity; confidence intervals; exercise; myocardial infarction; optimism