Optimism and Gratitude Effects After Acute Coronary Syndrome

Study Questions:

Do optimism and gratitude affect physical activity, biomarkers, and readmissions after acute coronary syndrome (ACS)?


The Gratitude Research in Acute Coronary Events Study included patients enrolled during admission for ACS between September 2012 and January 2014. Baseline assessment included Life Orientation Test-Revised, a measure of optimism, and the Gratitude Questionnaire-6 (GQ-6) for a measure of gratitude, which were completed at 2 weeks post-ACS. Additional measures included a measure of depression (the Patient Health Questionnaire-9) and anxiety (the seven-item Hospital Anxiety and Depression Scale anxiety subscale). Follow-up was through 6 months. Physical activity was measured primarily with accelerometry, controlling for baseline activity prior to ACS with a physical activity recall (PAR) questionnaire (the 7-day PAR). Biomarkers were measured as well, including C-reactive protein, interleukin-6 tumor necrosis factor-α, and soluble inter-cellular adhesion molecule-1).


A total of 164 patients who enrolled in the study and completed the baseline assessments at 2 weeks post-ACS were included in this analysis. 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.


The investigators concluded that post-ACS optimism, but not gratitude, was prospectively and independently associated with superior physical activity and fewer cardiac readmissions.


As the investigators note, given these results, testing an intervention to promote optimism among ACS patients would be warranted.

Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Prevention, ACS and Cardiac Biomarkers, Exercise

Keywords: Acute Coronary Syndrome, Anxiety Disorders, Biological Markers, Comorbidity, C-Reactive Protein, Exercise, Interleukin-6, Patient Readmission, Primary Prevention, Tumor Necrosis Factor-alpha

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