In Eurointervention, Joep Perk (Linnaeus University, Kalmar, Sweden) and others report that most patients do not appreciate that cardiovascular disease is a chronic condition with many believing that percutaneous coronary intervention (PCI) is a complete cure. The authors state that this shows that there is a need for considerable revision of cardiac rehabilitation.
Perk et al comment that although cardiac rehabilitation and prevention programmes are recommended for patients with coronary artery disease, many clinicians find motivating patients to participate in them difficult. They add: “Furthermore, in a recent Cochrane review, there was no evidence that education/information, which is an essential component of cardiac rehabilitation, reduced cardiac mortality or morbidity, revascularisation or hospitalisation.”
Therefore, the aim of their study was to evaluate the uptake and outcome of patient education after PCI; they reviewed the patients’ attribution of the cause of their acute cardiac event, the patients’ perception and understanding of the information provided by physicians, the content of post-PCI cardiac prevention and rehabilitation programmes and the willingness of patients to participate in these programmes, and the patients’ self-assessed change in lifestyle post PCI. Questionnaires were sent to 1,598 patients, of whom 67% (1,073) replied.
The authors report that patients more often attributed the cause of their cardiac condition to non-modifiable risk factors, such as genetics, than to modifiable risk factors (eg. smoking). However, younger patients (under 60 years) ranked modifiable risk factors higher than older patients. They note: “Many patients perceived the core message from the given information to be that they had been cured from their coronary artery disease through the PCI procedure. Barely one in four patients believed that they still had a cardiovascular disorder and they should consider lifestyle modification (one in three in the younger age group).”
Perk et al comment that 16% of patients continued to smoke after PCI and that only half of patients who were smokers were offered referral to a smoking cessation programme. However, most patients were invited to join a physical training programme (reflecting the fact that all hospitals in Sweden, the country in which the study took place, offer such initiatives for patients with coronary artery disease) and the majority of those invited accepted the offer (but only 39% of elderly patients did). The authors add: “Three-quarters of the patients received nutritional counselling commonly through an educational meeting with a dietician. After that, 40% decided to change and improve food habits (50% among the younger patients and 22% among the elderly). Almost half (45%) did not consume fruit and vegetables daily as recommended in the prevention guideline.”
According to the authors, their study shows that “there is a considerable need for an in-depth revision of cardiac rehabilitation in order to improve patient understanding of the disease and to support compliance with a cardioprotective lifestyle.”
Perk told Cardiovascular News: “There needs to be more focus on convincing patients of the need to take responsibility for their health, with core message ‘your future is mainly in your own hands’. Also, we need to create an easy to understand information model to enable all concerned healthcare workers provide a congruent message.”