Denial predicts favorable outcome in unstable angina pectoris

Denial may be prognostically favorable in patients with acute myocardial infarction. We analyzed the significance of denial in 26 patients referred to a tertiary care center for advanced therapy of unstable angina. Group A comprised 14 patients characterized as deniers on the Hackett--Cassem Denial Scale. Group B comprised 12 nondeniers. There were no differences between groups in multiple baseline social and demographic characteristics, cardiac history, or risk factors. Similarly, there were no differences in the number of diseased vessels or left ventricular function in those patients catheterized (11 Group A patients, 9 Group B patients). Group B, however, had a longer hospitalization until medically stabilized (pain-free for 36 hr) than Group A (5.9 +/- 3.6 days vs. 3.0 +/- 1.6 days; p = 0.02) despite similar treatment regimens. There were no significant differences in incidence of myocardial infarction or need for surgery. There were two deaths--both in Group B patients. We conclude that denial independently predicts rapid medical stabilization in unstable angina patients. Whether it predicts better longterm outcome requires further study.