Comorbidities are associated with state hopelessness in adults with ischemic heart disease

Background: In adults with ischemic heart disease (IHD), comorbidities and hopelessness are independently associated with increased risk of mortality.

Objectives: To determine if comorbidities were associated with state and trait hopelessness and explore the influence of specific conditions and hopelessness in individuals hospitalized for IHD.

Methods: Participants completed the State-Trait Hopelessness Scale. Charlson Comorbidity Index (CCI) scores were generated from the medical record. A chi-squared test was used to examine differences in 14 diagnoses included in the CCI by CCI severity. Unadjusted and adjusted linear models were used to explore the relationship between hopelessness levels and the CCI.

Results: Participants (n=132) were predominantly male (68.9%), with a mean age of 62.6 years, and majority white (97%). The mean CCI was 3.5 (range 0-14), with 36.4% having a score of 1-2 (mild), 41.2% with a score of 3-4 (moderate) and 22.7% with a score of ≥5 (severe). The CCI was positively associated with both state (β=0.03; 95% CI 0.01, 0.05; p=0.002) and trait (β=0.04; 95% CI 0.01, 0.06; p=0.007) hopelessness in unadjusted models. The relationship for state hopelessness remained significant after adjusting for multiple demographic characteristics (β=0.03; 95% CI 0.01, 0.05; p=0.02), while trait hopelessness did not. Interaction terms were evaluated, and findings did not differ by age, sex, education level, or diagnosis/type of intervention.

Conclusion: Hospitalized individuals with IHD with a higher number of comorbidities may benefit from targeted assessment and brief cognitive intervention to identify and ameliorate state hopelessness which has been associated with worse long-term outcomes.