After the myocardial infarction. A medical and psychological study with special emphasis on perceived illness

Abstract

Each year, more than 10,000 persons are admitted to Norwegian hospitals for a myocardial infarction (MI). The purpose of this study was to examine the medical, psychological, and social consequences of a MI, with special emphasis on the role of cognitive factors for the readjustment and coping process. Three hundred and eighty-three MI-patients below 67 years of age were followed by means of self- administered questionnaires during hospitalization and 1-2 weeks, 6 weeks, 6 months, and 3-5 years after the MI. In addition, a quasi- experimental evaluation of an in-hospital educational program was carried out. A high participation rate, relatively high reliability coefficients for methods developed for this study, and good correspondence with proxy information indicate satisfactory quality of data. Special attention was given to patients' cardiac health knowledge and expectations; two central aspects of perceived illness. Knowledge was represented by three scales covering basic understanding, lifestyle related aspects, and common misconceptions about coronary heart disease. Expectations were represented by four scales, pertaining to the subjective estimates of, respectively, reduced physical ability, autonomy, emotional control, and work capacity. Knowledge and expectations were only moderately correlated. Level of cardiac knowledge among the MI patients was primarily determined by socioeconomic status and amount of standardized information received during hospitalization. More negative expectations were strongly associated with hopelessness and a worse self-rated pre-MI health status. Self-assessed health was clearly reduced after the MI compared with pre-MI levels. About two-thirds of the patients were limited in their physical activities by chest pain or breathlessness. Over the 3-5 years follow-up period, about half of the surviving patients were readmitted to hospital; in more than two-thirds of the cases for heart-related reasons. Almost one third had a major recurrence, either death (17%) or a non-fatal reinfarction (14%). However, long-term use of physician consultations did not exceed that of the general population. Within 6 months, 73% of previously employed patients had returned to work with a mean sick-leave period of 15 weeks. Of previous smokers, 41% had resumed smoking 6 months after the MI whereas 49% smoked at the 3-5 years follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)