樂觀的心臟疾病患者預後較佳


  【24drs.com】根據一項線上發表在內科學誌的新研究詰果,罹患冠狀動脈血管疾病的患者,即使有這樣的診斷,如果他們期望自己會活得很好,比起悲觀的對照組患者,會存活地更久。
  
  北卡羅來納州杜克大學榮譽教授John C. Barefoot博士表示,我們早就知道病患對於疾病的信念對恢復有所影響,例如返回工作岡位並重新開始正常的生活形態;這項研究衍生了一個人的信念對於未來健康與存活確實是有影響的想法。
  
  研究人員針對2,818位患者(平均年齡為62歲)進行研究,這些患者有顯著的慢性肺阻塞疾病,且剛接受冠狀動脈血管攝影,在院時,詢問他們對恢復的期望。
  
  在試驗前以及之後的15年,每年評估患者的功能狀態。在這段時間,總共有1,637人死亡,其中885人死於心血管疾病。
  
  【存活機率更高】
  在控制許多變項後,包括年齡、性別、疾病嚴重度、併存疾病、社會協助、憂鬱症狀與功能狀態,研究人員發現中度樂觀的人們,覺得他們能夠復原且能回到正常生活形態,比起消極悲觀的人們,存活機率高出30%。
  
  Barefoot博士指出,憂鬱症對心臟血管恢復有負面影響,但是負面期待的效應顯然是獨立的。
  
  所以獨立於情緒之外,信念與期望確實有部份角色。
  
  Barefoot博士表示,樂觀的心臟疾病患者面對困境可能應付地更好;另一個可能性是,心臟疾病患者對自己復原有高度期待的話,可能壓力更小。
  
  我們不知道真正的答案是?但是有兩件事情對我們來說是很明顯的。
  
  Barefoot博士附帶表示,可能透過相對簡短的介入調適對於疾病的信念,同時暗示設計不需讓每個人都陽光正面的方法是可行的;我不認為你必須要變得不切實際地樂觀,但那將會正面地影響期待。
  
  【過度樂觀?】
  在隨後的主編評論中,紐約羅撤斯特大學的Robert Gramling醫師與Ronald Epstein醫師表示,因為樂觀對心臟健康與存活的效應,需要更多研究來解開此現象機轉的祕密。
  
  然而,過度樂觀也可能造成不好的預後。罹患嚴重、無法治療疾病的患者,若是過度樂觀,傾向於選擇負擔很大的治療,如果他們對整體存活有更平衡的瞭解,他們可能不會選擇這樣的治療。
  
  這些治療不但降低生活品質,也會惡化親人的喪親之痛,甚至可能縮短存活時間。要記得,很重要的是極端或是失去平衡的樂觀態度可能讓患者在知道他們身處的環境後,感到沒有準備、孤獨、且震驚。
  
  他們附帶表示,樂觀與消極不應被視為相斥的。最近的研究結果顯示,精神學家William James在100年前的觀察發現,發育良好的心智能同時考慮正面與負面思考,即使這些訊息可能是對立的。
  
  Gramling博士與Epstein博士的結論是,有嚴重疾病的人們經常期盼奇蹟,斷言奇蹟可能不會發生的過程會讓患者從希望及自重的好處做出更平衡的選擇。
  
  這項研究由國家心臟、肺臟與血管機構、國家高齡化機構贊助。Barefoot醫師、Gramling博士與Epstein博士表示沒有相關資金上的往來。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6470&x_classno=0&x_chkdelpoint=Y
  

Optimistic Heart Disease Patients Have Better Outcomes

By Fran Lowry
Medscape Medical News

March 1, 2011 — Patients with coronary heart disease who expect they will do well despite their diagnosis live longer than their pessimistic counterparts, according to a new study published online February 28 in Archives of Internal Medicine.

"We've known for a long time that a person's beliefs about their disease have an impact on certain aspects of recovery, such as going back to work and resuming a normal lifestyle. This study extends that knowledge to say that a person's beliefs actually have an effect on their future health and survival," John C. Barefoot, PhD, professor emeritus at Duke University in Durham, North Carolina, told Medscape Medical News.

The investigators queried 2818 patients (mean age, 62 years) with significant obstructive coronary artery disease who had just undergone coronary angiography about their expectations for recovery while patients were still in the hospital.

The patients' functional status was then assessed at baseline and then annually for 15 years. During that time, there were 1637 total deaths, 885 from cardiovascular causes.

Better Chance of Survival

After controlling for a number of variables, including age, sex, disease severity, comorbid conditions, social support, depressive symptoms, and functional status, the researchers found that moderately optimistic individuals who felt that they would be able to get better and return to a normal lifestyle had a 30% better chance of surviving than pessimistic individuals.

Depression has a bad impact on cardiovascular recovery but the effect of negative expectations appears to be independent of that, Dr. Barefoot pointed out.

"So there's something else going on about beliefs and expectations that is independent of the emotional aspect of it," he said.

Dr. Barefoot suggested optimistic heart patients may be better at coping with difficult situations. The other possibility, he said, is that heart patients with high expectations of a good recovery may experience less stress.

"We don't know what the real answer is here, but those are the 2 things that are most obvious to us," he said.

Dr. Barefoot added that it is possible to alter beliefs about disease with relatively short interventions and suggested that it may be feasible to devise some that would "not necessarily make everybody bubbly-positive; I don't think you want to become unrealistically optimistic, but that would affect expectations in a positive way."

Too Much of a Good Thing?

In an accompanying editorial, Robert Gramling, MD, and Ronald Epstein, MD, both from the University of Rochester in New York, suggest that given the magnitude of effect that optimism has on heart health and survival, "more research is needed to unveil the pathways underlying this phenomenon."

However, they note, too much optimism can lead to poor outcomes."Patients with serious incurable illness harboring unchallenged optimistic perceptions tend to choose burdensome treatments that they might not have chosen if they had a more balanced understanding of their overall prognosis," they write.

"These treatments not only lower their quality of life and complicate their loved ones' bereavement but also plausibly shorten survival. It is important to note that extreme or unbalanced optimism may leave patients unprepared, alone, and devastated when the reality of their situation sets in."

Optimism and pessimism should not be viewed as mutually exclusive, they add. Recent studies have confirmed an observation made more than 100 years ago by psychologist William James that "a well-developed mind can consider positive and negative thoughts simultaneously, even though the messages may seem contradictory.

"Individuals with serious illnesses frequently hope for a miracle, yet the process of affirming the possibility (or probability) that a miracle might not happen allows patients the benefits of hope and the dignity to make balanced choices," Dr. Gramling and Dr. Epstein conclude.

The study was supported by the National Heart, Lung, and Blood Institute and the National Institute on Aging. Dr. Barefoot, Dr. Gramling, and Dr. Epstein have disclosed no relevant financial relationships.

Arch Intern Med. Published online February 28, 2011.

    
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