Overall Research Project Description This interdisciplinary study will evaluate long-term survival effects of psychological strength factors (e.g., spirituality, character strengths) in an PI’s (Ai’s) existing sample of older patients who underwent open-heart surgery (N=481, female 42%). It significance lies in several facts. Nearly 92.1 million American adults have some form of cardiovascular diseases that accounts for 1 of every 3 deaths in the US. Costly open-heart surgery is a life-saving/extending achievement in cardiac medicine but is also a stressful life event. Further, recent population students have shown health benefits of psychological strength factors in aging—health relevant areas, especially survival benefits of religiousness/ spirituality and character strengths, mostly in general populations. Yet, studies have rarely examined the survival benefit of psychological strength factors in clinical cardiac patients over a decade. Moreover, aligned with the World Health Organization’s concept of health with a whole-person’s view, a JAMA article posits that spiritual interconnection could inform future strategies for both public health and individualized, patient-centered care. It also noted that health providers have paid limited attention to such psychological strengths that can be an impetus for promoting healthy behaviors. Clearly, more clinical research is needed to provide robust evidence on potential protection of strength factors to advance this area of studies. The PI’s publications on this sample have showed the positive role of preoperative strength factors (e.g., optimism/ hope, sense of reverence in secular contexts, positive religious coping, using prayer for coping) in short-term recovery. Based on the literature in three interrelated areas (Spirituality, Aging, and Health, Positive Psychology and Health, and Psychological Resilience), the proposed study aims to address important unanswered questions.