Hopelessness greater in heart disease patients with comorbid conditions

Individuals with ischemic heart disease are at a higher risk for hopelessness — a negative outlook and sense of helplessness towards the future – if they also have other diseases or health conditions, known as comorbidities, according to a paper published online in March in the journal Heart & Lung.

This is important because “both [hopelessness and comorbidities] are predictive of death in patients with ischemic heart disease,” said Susan Dunn, associate professor in the UIC College of Nursing’s biobehavioral nursing science department, who was senior author on the paper. Heart disease is the No. 1 cause of death and disability globally.

“Really, the take home message with this paper is the importance of assessing patients for hopelessness, especially those who have a number of comorbidities,” Dunn said. “For example, if a patient has a history of diabetes and hypertension and now they have heart disease, we need to be assessing whether they or not they are feeling hopeless about their recovery and their life in order to improve their outcomes.”

Dunn is the principal investigator on an ongoing five-year, $2.4 million NIH-funded study called “Heart Up!” – a randomized, controlled trial to reduce hopelessness in patients with ischemic heart disease through physical activity. The paper analyzed baseline data from 132 patients enrolled in the study.

“The largest generation of Americans have now reached retirement age, and age is a non-modifiable risk for the development of comorbid conditions,” said Holli DeVon, UIC Nursing professor emerita and Audrienne H. Moseley Chair in Community Research at UCLA School of Nursing, who was lead author on the paper. “While age can’t be modified, risk factors can be. Focusing on mental and physical health is a positive step that will help reduce poor outcomes.”

Dunn notes that hopelessness is not commonly assessed or measured, even though it has been identified in 27% to 52% of patients with ischemic heart disease and is predictive of death, independent of depression. Hopelessness is considered distinct from depression. People who are depressed can be hopeless, yet hopelessness can also stand alone, Dunn said.

The paper distinguished between “state hopelessness,” a temporary response to a new event, or “trait hopelessness,” a habitual outlook on life. When controlling for other factors, such as age, marital status, sex and other demographics, “state hopelessness” — or how the patient was currently feeling — was significantly associated with heart disease patients who also had comorbidities, according to the paper.

“These patients are suffering from hopelessness and, essentially, we’re doing little to alleviate or help treat that in patients,” Dunn said.

Hospitalized patients with heart disease and a higher number of comorbidities could benefit from short-term cognitive interventions by a trained clinician, which could be integrated into a cardiac rehab program designed to improve cardiovascular health, the paper’s authors write. The American Heart Association recommends goal setting, motivational interviewing, self-monitoring, self-efficacy enhancement and identification of barriers to change as effective short-term cognitive behavioral strategies, according to the paper.

In addition to Dunn and DeVon, co-authors include: Nathan Tintle, Ulf Bronas, Sahereh Mirzaei, Eleanor Rivera, Melissa Gutierrez-Kapheim, Windy Alonso, Steven Keteyian, and Madison Goodyke.

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