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The Impact of Gratitude on Biology and Behavior in Persons With Heart Disease (GRACE)

This study has been completed.
University of California, Berkeley
Information provided by (Responsible Party):
Jeff C. Huffman, MD, Massachusetts General Hospital Identifier:
First received: September 21, 2012
Last updated: August 7, 2014
Last verified: August 2014

Overall, the investigators aim to recruit 150 subjects during their hospitalization for an acute coronary syndrome (ACS). At two weeks post-ACS, the investigators will assess levels of gratitude, draw blood for baseline levels of biomarkers, gather baseline information about health behaviors critical to cardiac health, and obtain baseline measures of symptoms and function. Finally, the investigators will repeat assessments of biomarkers, behavior, and function at 6 months to allow us to assess the impact of gratitude on these outcomes; the investigators will also have an objective measure of physical activity via accelerometer (step counter) at 6 months.

Specific Aim #1: To prospectively assess the association between gratitude 2 weeks after ACS and improvement in biological markers of cardiac health at 6 months post-ACS.

Hypothesis: Higher levels of gratitude at 2 weeks will be associated with greater reductions in levels of biomarkers associated with negative heart health between 2 weeks and 6 months.

Specific Aim #2: To assess the association between gratitude 2 weeks after ACS and subsequent adherence to health behaviors known to improve post-ACS prognosis at 6 months.

Hypothesis: Higher levels of gratitude at 2 weeks will be associated with greater amounts of physical activity (measured by accelerometer) at 6 months, and greater improvements in self-reported adherence to health behaviors (diet and medication) between 2 weeks and 6 months.

Specific Aim #3: To assess the association between gratitude at 2 weeks and other critical medical, functional, and psychological outcomes at 6 months.

Hypothesis: Higher levels of gratitude at 2 weeks will be associated with greater improvements in depression, health-related quality of life, function, cardiac symptoms, and possibly readmissions, between 2 weeks and 6 months.

Myocardial Infarction
Unstable Angina

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: The Impact of Gratitude on Biology and Behavior in Persons With Heart Disease

Resource links provided by NLM:

Further study details as provided by Massachusetts General Hospital:

Primary Outcome Measures:
  • Change in GQ-6 scores [ Time Frame: At 2 weeks, 3 months, and 6 months after ACS ] [ Designated as safety issue: No ]
    The Gratitude Questionnaire 6 is a brief, validated six-item measure of dispositional gratitude.

Secondary Outcome Measures:
  • Change in Biomarkers [ Time Frame: 2 weeks and 6 months after ACS ] [ Designated as safety issue: No ]
    Levels of inflammation (IL-6), endothelial dysfunction (VEGF), cardiac cell damage (high sensitivity troponin T), lipid levels, and overall cardiac prognosis (NT-proBNP)

Other Outcome Measures:
  • Change in Physical Activity [ Time Frame: Intake and 6 months after ACS ] [ Designated as safety issue: No ]
    Subjects' level of physical activity as measured by an activity recall log and number of steps taken over a two week period measured by an accelerometer.

  • Change in Depression [ Time Frame: 2 weeks, 3 months, and 6 months ] [ Designated as safety issue: No ]
    Patient Health Questionnaire-9 (PHQ-9)

  • Change in Anxiety [ Time Frame: 2 weeks, 3 months, and 6 months ] [ Designated as safety issue: No ]
    Hospital Anxiety and Depression Scale (HADS)

  • Change in Health-Related Quality of Life [ Time Frame: 2 weeks, 3 months, and 6 months ] [ Designated as safety issue: No ]
    MOS Short Form-12 (SF-12)

  • Change in Function [ Time Frame: 2 weeks, 3 months, and 6 months ] [ Designated as safety issue: No ]
    Duke Activity Symptom Index (DASI)

  • Change in Cardiac Symptoms [ Time Frame: 2 weeks, 3 months, and 6 months ] [ Designated as safety issue: No ]
    A cardiac symptom scale adapted from the Women and Ischemia Syndrome Evaluation (WISE) study

  • Readmissions [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Number of readmissions to the hospital

Biospecimen Retention:   Samples Without DNA

Analyzed Blood Samples:

Subjects will have a blood draw for the following biological factors that are important to cardiac health and may be modified by psychological states: Inflammation will be measured via interleukin-6 (IL-6), cardiac ischemia (ongoing heart damage) will be measured via high sensitivity Troponin T (hsTnT), endothelial function/angiogenesis will be measured by vascular endothelial growth factor (VEGF), overall cardiac prognosis will be assessed using N-terminal pro-brain natriuretic peptide (NT-proBNP), and lipid levels will be assessed by a fasting lipid profile. A total of 15 ml/cc of blood will be drawn (this is equivalent to 3 tablespoons of blood).

Retained Blood Samples:

Given that additional, more sensitive/critical markers of cardiac outcomes may be identified in the near future, participants will be given the option to allow us to store their blood samples for additional biomarker analysis.

Enrollment: 212
Study Start Date: September 2012
Study Completion Date: August 2014
Primary Completion Date: August 2014 (Final data collection date for primary outcome measure)
Enrolling by invitation

  Show Detailed Description


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Patients admitted to the Ellison Cardiac Care Units at Massachusetts General Hospital.


Inclusion Criteria:

  • Adult patients admitted to cardiac units at MGH with a primary admission diagnosis of ACS (eligible patients must meet World Health Organization criteria66 for myocardial infarction or criteria for unstable angina [new-onset angina within 2 months, exacerbation of previous angina with rest pain or with minimal exercise, or angina within 2 weeks of MI42]). ACS diagnosis will be clarified with the inpatient care team and adjudicated by co-investigator cardiologist Dr. Januzzi as needed.

Exclusion Criteria:

  • 'Periprocedural' ACS (ACS that occurs in the setting of another medical procedure; such events may occur in the absence of structural heart disease and likely represent a different pathophysiology, course and prognosis than those with 'endogenous' ACS).
  • Conditions likely to alter biomarkers of interest (renal failure requiring hemodialysis, inflammatory disease [e.g., systemic lupus erythematosus])
  • Condition likely to lead to death within 6 months (e.g. cancer).
  • Inability to complete physical activity due to unrelated medical condition (e.g., severe arthritis)
  • Inability to complete self-report evaluations due to inability to speak or write in English or due to cognitive deficits (assessed using an established six-item screen).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01709669

United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital
University of California, Berkeley
Principal Investigator: Jeff Huffman, M.D. Massachusetts General Hospital
  More Information

No publications provided

Responsible Party: Jeff C. Huffman, MD, Medical Director, Blake 11, Massachusetts General Hospital Identifier: NCT01709669     History of Changes
Other Study ID Numbers: 2012P001191
Study First Received: September 21, 2012
Last Updated: August 7, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Massachusetts General Hospital:
acute coronary syndrome
health behavior
myocardial infarction
unstable angina

Additional relevant MeSH terms:
Angina, Unstable
Heart Diseases
Myocardial Infarction
Angina Pectoris
Cardiovascular Diseases
Chest Pain
Myocardial Ischemia
Pathologic Processes
Signs and Symptoms
Vascular Diseases processed this record on November 25, 2014