Focus on modification of risk factors and patients' perception of lifestyleBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6978.533 (Published 25 February 1995) Cite this as: BMJ 1995;310:533
- Gregory Y H Lip,
- Richard Balasubramaniam,
- Andrew Maurice,
- Gareth Beevers
- Research fellow Medical student Medical student Professor of medicine University of Birmingham, City Hospital, Birmingham B18 7QH
EDITOR,—M E Cupples and A McKnight conclude that personal health education of patients with ischaemic heart disease had no significant effect on objective cardiovascular risk factors, although some beneficial effects on exercise and diet were seen.1 In a preliminary survey of hospital inpatients recovering from an acute myocardial infarction we have come to broadly similar conclusions.
Using a structured questionnaire, we surveyed 23 patients (19 men, four women; mean age 63.5 years (range 37-81) within five years of admission with an acute myocardial infarction and three months later, after a cardiac rehabilitation programme. We assessed their overall awareness of their condition and their self reported profile of risk factors and intended modifications to their lifestyle immediately after the infarct and at three months' follow up. Sixteen patients considered that they were more aware of their condition at follow up; six, however, reported that they were neither more nor less aware of their condition, and 10 considered that too little had been explained to them about their treatment, despite the rehabilitation programme.
There was a significant reduction in the prevalence of smoking and in stressful lifestyles after the infarction. Diet and the amount of regular exercise, however, were not significantly different (table). Intended changes in lifestyle also differed when patients were interviewed immediately after infarction and at three months' follow up. In particular, attitudes towards eating a healthy diet changed significantly (P<0.05). There was, however, no significant change in intended exercise routine and the patients' perception of their career or employment, family life, driving ability, or social life (table).
Our patients, who were educated about cardiovascular risk factors and underwent a risk factor modification programme after an acute myocardial infarction, reported an increased awareness of their condition. Changes in risk factors remained limited, although the prevalence of smoking and a stressful lifestyle fell, and the rehabilitation programme seemed to have only a limited effect on the patients' perception of their career, family life, driving ability, and social life. To become more effective the current programmed approach to cardiac rehabilitation after myocardial infarction may need to place more emphasis on modification of risk factors and on the patients' perception of lifestyle.