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Expert Viewpoint: Hope for heart patients

Associate professor Susan Dunn has spent most of her career focused on the care of adults with heart disease; most concerning to her have been patients who experience a condition known as hopelessness Heading link

Susan Dunn

“Working in a cardiac rehabilitation facility, I saw a 60-year-old patient—let’s call him Mr. Jeluso—who had recently had a heart attack and coronary artery stent placement. Mr. Jeluso was obese, lived a sedentary lifestyle and had been referred to the cardiac rehab exercise program. Yet, he chose not to attend, making comments such as, ‘I’m sure exercise won’t help,’ ‘I’m doomed to die of heart disease,’ and, ‘It is out of my hands.’

“Based on my years of clinical experience and research, I didn’t believe that he was suffering from depression. Depression often occurs as a grief response to the past, and includes symptoms of depressed mood or sadness, apathy, loss of interest in usual activities, and changes in appetite, energy level or sleep. Mr. Jeluso wasn’t exhibiting those symptoms.

“Instead, I believed Mr. Jeluso was suffering from hopelessness.

“Hopelessness is present in 27% to 52% of heart patients, which is a very concerning statistic. Other researchers have found hopelessness to be highly predictive of death in heart patients, independent of depression. Hopelessness is associated with a three times increased risk of death.

“There is confusion about the difference between depression and hopelessness. Hopelessness is negative feelings and expectations about the future and also a sense of helplessness in being able to change one’s future. People who are depressed can be hopeless, yet hopelessness often stands alone.

“The problem is that we are doing very little to try to decrease or prevent hopelessness. Antidepressants are primarily ineffective in treating hopelessness. In the patients I have examined in my research, depression decreases over time. Hopelessness does not decrease in heart patients; instead it persists.

“In my research, the one thing that I found to improve hopelessness is exercise. Patients who exercise after their heart event have significantly lower hopelessness levels. In a pilot study of patients with moderate to severe hopelessness, we found that patients increased their physical activity level after a nurse-led intervention that included a motivational interviewing session and six weeks of motivational text messages. We’re now expanding that pilot to a five-year, $2.4 million NIH-funded study of 225 patients.

“As practicing nurses, we need to be assessing patients for hopelessness. My State-Trait Hopelessness Scale (used to differentiate a temporary response to a new event versus a patient’s habitual outlook on life) is being used in eight countries and readily available for both practitioners and researchers. If you have a patient who is exhibiting hopelessness symptoms, encourage them to be more physically active, even at home or in their community. This could mean walking more around their house, in their neighborhood or at a mall, or joining an exercise group or gym.

“My research has focused on individuals with heart disease, but hopelessness has been identified by other researchers in patients with cancer, HIV/AIDS and stroke. My hope is that my intervention could be appropriate for any patient who has chronic illness, because we know physical activity can improve hopelessness and overall health and recovery.”

Dunn joined the Department of Biobehavioral Health Science in 2018. To learn more about her State-Trait Hopelessness Scale, contact her at