Optimism During Hospitalization for First Acute Myocardial Infarction and Long-Term Mortality Risk: A Prospective Cohort Study Netanela Weiss-Faratci, MPH; Ido Lurie, MD, MPH; Yael Benyamini, PhD; Gali Cohen, MSc; Uri Goldbourt, PhD; and Yariv Gerber, PhD Abstract Objective: To assess the association between dispositional optimism, defined as generalized positive ex- pectations about the future, and long-term mortality in young survivors of myocardial infarction (MI). Patients and Methods: A subcohort of 664 patients 65 years and younger, drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, completed an adapted Life Orientation Test (LOT) questionnaire during their index hospitalization between February 15, 1992, and February 15, 1993. Additional sociodemographic, clinical, and psychosocial variables were assessed at baseline; mortality follow-up lasted through December 31, 2015. Cox proportional hazards regression models were fit to assess the hazard ratios for mortality associated with LOT-derived optimism. Results: The mean age of the participants was 52.4Æ8.6 years; 98 (15%) were women. The median follow-up period was 22.4 years (25th-75th percentiles, 16.1-22.8 years), during which 284 patients (43%) had died. The mean LOT score was 16.5Æ4.1. Incidence density rates for mortality in increasing optimism tertiles were 25.4, 25.8, and 16.0 per 1000 person-years, respectively (P<.01). With sequential adjustment for sociodemographic, clinical, and psychosocial variables, a decreased mortality was associated with the upper tertile (adjusted hazard ratio, 0.67; 95% CI, 0.47-0.95). A nonlinear inverse relationship was observed using spline analysis, with the slope increasing sharply beyond the median LOT score. Conclusion: Higher levels of optimism during hospitalization for MI were associated with reduced mortality over a 2-decade follow-up period. Optimism training and positive psychology should be examined as part of psychosocial interventions and rehabilitation after MI. ª 2016 Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2016;nn(n):1-8 W ith the emergence of a bio- psychosocial approach toward understanding health and disease in recent years, a number of factors related to one’s psychological well-being have been iden- tified as health predictors. An example of such a factor is optimism, an important construct within the field of positive psychology, 1 which has previously been associated with mortality and other adverse health outcomes both in the general population and in selected patient cohorts. 2-4 Optimism is primarily conceptual- ized either as optimistic explanatory style or as dispositional optimismdthe first signifying how people explain events that happen to them 5 and the second representing a general expectation that good things will happen in the future. 6 Several ways in which both models may affect one’s health via physiological 7-10 and psychosocial 11-14 mechanisms have been considered. Moreover, it was recently sug- gested that psychological interventions may in- crease the level of optimism, 15,16 highlighting the potential clinical implications, with (lack of) optimism as a modifiable risk factor. A number of studies specifically evaluated the role of dispositional optimism in cardiovas- cular morbidity and mortality, 17-20 reporting an inverse association with coronary heart dis- ease, 20 stroke, 21 and heart failure 22 incidence. Dispositional optimism has also been associ- ated with recovery from cardiovascular disease (CVD), 23,24 as exhibited by lower rates of car- diac readmission and better physical and emotional health after acute coronary syn- drome, 25,26 lower risk of rehospitalization after bypass surgery, 24 higher quality of life after heart transplant, 27 and generally a lower risk From the Braun School of Public Health and Com- munity Medicine, Hebrew University-Hadassah, Jeru- salem, Israel (N.W.-F.); Kfar Saba Adult Clinic, Shalvata Mental Health Center, Hod Hasharon, Israel (I.L.); and Depart- ment of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medi- cine (I.L., G.C., U.G., Y.G.) and Bob Shapell School of Social Work (Y.B.), Tel Aviv University, Israel. ORIGINAL ARTICLE Mayo Clin Proc. n XXX 2016;nn(n):1-8 n http://dx.doi.org/10.1016/j.mayocp.2016.09.014 www.mayoclinicproceedings.org n ª 2016 Mayo Foundation for Medical Education and Research 1