Patients' Attitudes To Cardiac Problems

29.11.05

Attitudes to risk of cardiac problems:
• Good lay understanding of risks.
-Coronary candidate: overweight, smoker, little exercise, poor diet etc.
• Beliefs about exceptions.
-Davison et al 1989, 1992.
-"Uncle Norman" and "the last person you'd expect."
• "It's a man's disease."
-Misconception reinforced by medical and scientific research and health promotion campaigns.
• "It's a good way to go."
-Perceived leading cause of death: 41% said heart disease.
-Most important personal health concern: 9% said heart disease (Shepherd, 1998).
• Attitudes about sociological and psychological factors as cause.
-Beliefs about links between stress/strain and cardiac problems are common in patients.
• Highly-stressed executive?
-"Type A" behaviour and coronary heart disease (Rosenman et al 1975).
• Hostility?
-As well as other personality traits.

What are the sociological and psychological risk factors?
• Social class (50% high in manual workers).
• Ethnicity (50% high in South Asians).
• Low status, but demanding occupations with little control.
• Poor social support.
• Depression.

Preventative drug treatment: attitudes about risks and benefits
• Views of doctors, nurses and lay people about minimum benefit needed to justify drug treatment to prevent heart disease (2003).
• Doctors: 5-10 people (out of 100).
• Nurses: 10-25 people.
• General public: 10-99 people.
• Questions included: cost; side-effects; guaranteed effectiveness; lifestyle changes.

Perceiving acute symptoms of cardiac problems:
• Delay in consulting for chest pain associated with:
-Atypical symptoms.
-Not seeing symptoms as cardiac in origin.
-Less knowledge of heart attack symptoms (Rushton et al 1998).

Responding to chronic symptoms
• Reluctance to consult in patients with angina - FEARS, beliefs.
• Socio-economic background important - people from poor areas have:
-Greater perceived vulnerability.
-More exposure to ill health, so normalise symptoms.
-More anxious about seeing doctor.
-Richards et al, 2002.

Ideas about illness
• Illness representations/beliefs (Leventhal et al 1980).
-Identity ie. label/name given to illness (positive? Negative?)
-Causes ie. of illness - beliefs; stress.
-Timeline ie. how long patient expects illness to last.
-Ongoing? Curable?
-Consequences ie. what it will mean to patient's life.
-Cure and controllability ie. can it be kept under control? Lead an ordinary life?
• Impact on how people react to their illness.

Ideas about illness and recovery after myocardial infarction
• Illness perceptions soon after admission for myocardial infarction predicted recovery.
• Perception of myocardial infarction by patients is better predictor of recovery than medical judgements of severity of myocardial infarction.
• Petrie et al, 1996.

Psychological outcomes after myocardial infarction
• After 12 weeks, 30% myocardial infarction patients report quality of life has returned to previous levels.
• 15-30% depressed at 6 months.
• 50% have high anxiety levels.

Social/psychological influences on recovery
• Anxiety/depression.
-Hemingway and Marmot (1999) 6/6 studies found association between depression/anxiety and survival from coronary heart disease.
-Strength of association similar to that of smoking and coronary heart disease.
-Implication: important that depression/anxiety diagnosed and treated.
• Social isolation and lack of social support.
-Hemingway and Marmot (1999) 9/10 studies found association between social support and survival from coronary heart disease.
-Associated with threefold increased risk of poorer outcomes (Bunker et al, 2003).

Cardiac rehab
• Combination of exercise, psychological and educational interventions.
• Can promote recovery, enable patients to maintain health and reduce risk of death.
• Many problems in patients with heart disease due to anxiety and misconceptions about their health.

Psychological influences on recovery: stress
• Stress: process by which we perceive and respond to certain events that we appraise as threatening (Myers, 1998).
• "There is nothing either good or bad, but thinking makes it so." - Hamlet, Shakespeare.
• Patients' beliefs about cardiac problems and stress need to be addressed.
• Stress management training can help.
-Identify challenges.
-Reduce challenges (where appropriate).
-Reappraise challenges.
-Problem-focused coping.
-Relaxation training/techniques.
-Social support.