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Denial and medical outcome in unstable angina
J L Levenson1, A Mishra, R M Hamer
1Department of Psychiatry, Medical College of Virginia, Virginia Commonwealth University, Richmond.
Insights
Denial can be adaptive for patients hospitalized with acute coronary syndrome. High deniers experienced less angina and achieved better medical stabilization compared to low deniers.
Area of Science:
- Cardiology
- Psychological Medicine
Background:
- Denial as a psychological coping mechanism.
- Potential adaptive role of denial in acute medical conditions.
Purpose of the Study:
- To investigate the impact of denial on patient outcomes during hospitalization for unstable angina.
- To compare clinical outcomes between high and low deniers.
Main Methods:
- Study included 48 patients with unstable angina.
- Patients were assessed using the Hackett-Cassem Denial Scale, categorizing them into high (25) and low (23) deniers.
- Groups were compared on baseline characteristics, cardiac history, treatment, and hospitalization outcomes.
Main Results:
- High deniers reported significantly fewer angina episodes (1.3 vs. 2.5) compared to low deniers.
- A higher percentage of high deniers achieved medical stabilization (92% vs. 65%).
- High deniers required less frequent intravenous nitroglycerin (32% vs. 78%); all adverse events (2 MIs, 1 death) occurred in low deniers.
Conclusions:
- Denial independently predicts a better medical outcome during acute hospitalization for unstable angina.
- The findings suggest denial may serve an adaptive function in this patient population.
Abstract:
Denial may be adaptive during hospitalization for acute coronary disease. We studied the impact of denial in 48 patients referred to a tertiary care center for treatment of unstable angina. Using the Hackett-Cassem Denial Scale, we divided the group into 25 high deniers and 23 low deniers. The two groups were comparable in baseline demographic and social data, coronary risk factors, cardiac history, medical treatment, vital signs, and cardiac catheterization results (number of diseased vessels and ejection fraction). Compared to low deniers, high deniers had half as many episodes of angina during hospitalization (1.3 vs. 2.5; p less than 0.03, t = 2.2, df = 46) and were more likely to reach medical stabilization, i.e., pain free for 36 hr (92% vs. 65%, p less than 0.03, Fisher exact probability test). Intravenous nitroglycerin drips were also required less often in high deniers (32% vs. 78%, p = 0.002, Fisher exact). Two myocardial infarctions and one death occurred, all in low deniers. We conclude that denial independently predicts better medical outcome during acute hospitalization for unstable angina.