Henry Ford Study Finds That Denial May Kill Cardiac Patients

March 19, 1997

DETROIT -- We've all heard that anger can kill. Yet for cardiac patients, perhaps denial of anger is even more deadly.

Denial of anger emerged as a stronger predictor for death and other cardiac incidents, such as new heart attacks or additional cardiac procedures, than traditional cardiac risk factors, according to a Henry Ford Hospital study conducted by Mark Ketterer, Ph.D.

Results of this study were presented at the American Psychosomatic Society Annual Meeting, held March 19-22 in Santa Fe, N.M.

"The results of this study make a strong case for doctors to routinely ask a spouse or friend about the patient's emotional well-being," Dr. Ketterer said. "Patients tend to minimize what is really happening."

Researchers discovered that patients routinely under-reported anger. In fact, it was more likely to be minimized than depression or anxiety. This makes it difficult for physicians to accurately assess patients' emotional risk factors and direct them to appropriate therapy.

The study evaluated measures of emotional distress, in addition to standard cardiovascular risk factors, to determine which are the most potent predictors of additional cardiac incidents or death. It also examined how to determine which patients will benefit from evaluation and intervention for emotional distress.

"It is striking that standard cardiovascular risk factors largely failed to predict cardiac events or chest pain," Dr. Ketterer said. "This study shows that denial of emotional distress is a powerful predictor of long-term outcomes and points out that patient distress is not likely to be apparent to the physician."

The study involved 144 men who underwent coronary catherization between 1989 - 1991, had no history of previous cardiac procedures or mental disorders, and whose baseline coronary artery disease was determined by angiography, a procedure which provides an image of the blood vessels to the heart. Each patient and a spouse/friend completed parallel versions of the Ketterer Stress Symptom Frequency Checklist at that time, which evaluated the patient's emotional well-being.

Patients or surviving family were followed up by phone an average of five years after their catherization. Patients who had experienced one or more cardiac events or death were compared with those not experiencing events on traditional risk factors and a number of measures of psychosocial/emotional distress.

Of the traditional cardiac risk factors, only the number of hours of exercise per week and a history of hypertension were found to predict cardiac events.

Denial scores, which are the difference between what the patient and the spouse reported, proved to be the strongest predictor of cardiac events. Denial of anger had the strongest association observed for cardiac events or death, even over traditional cardiac risk factors.

Dr. Ketterer believes that more support groups are needed for cardiac patients to address the emotional and psychological issues of their disease.

In addition, Dr. Ketterer believes that future research and clinical care need to take reports of emotional status from the spouse/friend into account to effectively evaluate and treat patients.
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Henry Ford Health System

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