UPBEAT study patients' perceptions of the effect of coronary heart disease on their lives: a cross-sectional sub-study

Background
Patients can report positive effects of myocardial infarction. It is unknown whether these effects are sustained or what factors influence adaptation.

Objectives
To explore primary care patients’ perceptions of the effect of coronary heart disease and to identify possible modifiable predictors of adaptation.

Design and Setting
Cross-sectional, sub-study of UPBEAT cohort participants. Patients were recruited from coronary heart disease Registers in South London General Practices

Method
548 participants were asked “Has having heart disease changed your life? If so, was that change for the better, worse, both or neither?” Participants were asked to explain their response; explanations were subjected to content analysis. Associations between response and lifestyle, demographic, mood and coronary heart disease variables were tested.

Results
Respondents (394 male, 72%) were aged 27 to 98 years and had had heart disease for a mean of 12.4 SD ± 8.4 years. 120 (22%) reported that life was better and 200 (37%) said it was worse. The explanations of those who said ‘better’ were categorised as ‘Healthier Living’, ‘Recognised Mortality’ and ‘Stress Reduction’. For those saying ‘worse’, categories were ‘Restricted Lifestyle’, ‘Recognised Mortality’, ‘Loss and Burden’. More anxiety symptoms (RRR 1.56, 95% CI 1.12, 2.17), lower functional status (RRR 2.46, 95% CI 1.21, 4.98) and self-reported chest pain (RRR 2.24, 95% CI 1.34, 3.77) were associated with saying ‘worse’.

Conclusions
Many primary care patients are ambivalent to the effects of coronary heart disease, but some report positive effects. Negative perceptions are associated with reported functional impairment, chest pain and anxiety, but not illness severity or patient characteristics. Future work will track the implications of these perceptions, but nurses managing patients with coronary heart disease should consider these effects as they may be modifiable predictors of adaptation.