Optimistic people with chronic angina pectoris experienced better health status outcomes than their less optimistic counterparts, according to the results of a recent study.1

“A large and growing body of evidence suggests that patients’ experience of illness is important for chronic disease outcomes,” says Alexander Fanaroff, MD, the study’s lead author and an assistant professor of medicine at the University of Pennsylvania.

Patients’ beliefs about their illness and overall mood are strongly associated with angina severity. “For patients with coronary artery disease, angina is correlated only weakly with anatomic disease burden,” Fanaroff reports.

Fanaroff and colleagues studied 2,389 patients with chronic angina who had recently undergone coronary revascularization with percutaneous coronary intervention. Researchers wanted to know if patient attitudes were associated with ischemia-driven healthcare use and angina symptoms.

“If less optimistic patients with chronic angina were more likely to undergo ischemia-driven hospitalization or revascularization, then interventions to change patients’ beliefs about their likelihood of returning to normal function may be useful,” Fanaroff says.

Most patients with chronic angina will recover normal physical function through some combination of medication, revascularization, and time. “This is a particularly ripe area to try such an intervention,” says Fanaroff.

The researchers found that higher levels of baseline optimism were, in fact, associated with lower rates of ischemia-driven hospitalization and revascularization. This group of patients showed greater improvements in angina severity compared with lower levels of baseline optimism. “These findings are surprising on one level because they demonstrate that patients’ mental state may affect ‘hard’ healthcare outcomes,” Fanaroff explains.

Conversely, the findings confirm what many cardiologists have known for a long time. “Instilling a sense of optimism following revascularization is something that we routinely do,” Fanaroff says.

Cardiologists know that stable angina is a chronic disease characterized by exertional angina attacks that do not cause heart damage, which can be managed effectively with medicine. In contrast, says Fanaroff, “patients may think that each exertional angina attack is a heart attack and may cause them to die.”

Talking about the pathophysiology of stable angina and what makes it different from heart attack can help patients understand their relatively benign prognosis. In the study, Fanaroff and colleagues asked patients how much they agreed with the phrase “I am optimistic about my future and about returning to a normal lifestyle.”

“This is not a question most physicians normally ask patients. Nor is it even the type of question most physicians normally ask patients,” Fanaroff observes.

In clinical practice, in addition to asking about a patient’s optimism level, physicians can add another question: “What do you think it will be like to live with angina?”

“This can be a great way to understand patients’ state of mind and level of optimism to see if it matches with their prognosis,” Fanaroff offers.

Ethicists can encourage physicians, advanced practice providers, and nurses to identify patients who seem less optimistic than they should be. “This may improve patients’ outlook and outcomes,” Fanaroff adds.


  1. Fanaroff AC, Prather K, Brucker A, et al. Relationship between optimism and outcomes in patients with chronic angina pectoris. Am J Cardiol 2019;123:1399-1405.