Recovery after myocardial infarction. Effects of a caring rehabilitation programme

The aim of the study was to evaluate a multifactorial rehabilitation programme based on interdisciplinary caring efforts for myocardial infarction (MI) patients. Randomly chosen MI-patients participated, either in a six-month rehabilitation programme (intervention group = 53) or in routine cardiac follow-ups (control group = 63). Subjective and objective instruments were used for measuring their health recovery. Biophysical improvements were showed as an increased physical capacity (p less than 0.001) using a submaximal exercise test six months after MI, and less reinfarctions (p less than 0.024) twelve months after MI, to the intervention patients' advantage. Psychological improvements were demonstrated in a higher life satisfaction (p less than 0.001) six months and (0.1 greater than p greater than 0.05) twelve months after MI to the intervention patients' advantage. Social improvements were indicated as a better leisure situation (p less than 0.004) six months after MI, and as a better partner situation (p less than 0.010), including a less influenced sex life (p less than 0.017), twelve months after MI to the intervention patients' advantage. As to the overall view, the caring rehabilitation programme appeared to be required for the MI-patients' health recovery. In order to be able to reach an optimal state of human health, an even more individualised programme seems to be necessary.     

Myocardial infarction: a turning point in meaning in life over time

Finding meaning in illness appears to give individuals purpose in life, which may motivate them to maintain a healthy lifestyle. Research to date has mainly used cross-sectional designs in the acute phase of recovery. This article describes a longitudinal exploratory study which explored patients' search for meaning in life across the first 5 years following myocardial infarction (MI). Interviews were conducted between 2000 and 2007 on patients with first MI (n=70; mean=61.9 years; SD=12.1). The qualitative data underwent thematic analysis guided by the analysis framework of Burnard (1991). Finding meaning appeared to increase patients' awareness of their current holistic state of life, and to provide impetus for making lifestyle changes. In the immediate aftermath of MI, patients restructured and re-evaluated their attitudes towards self, life, religious beliefs and others. However, from the third year onwards, as time passed patients lapsed in their behaviour, tending to become non-compliant with treatment and less aware or concerned about the risk of another heart attack. Further education on the spiritual dimension in care may guide nurses and health professionals in order to promote patients' rehabilitation process and persevere with a long-term healthy lifestyle. Further longitudinal comparative research with mixed method approach on various groups of patients is recommended to support these findings.     

Managing consequences and finding hope--experiences of Swedish women and men 4-6 months after myocardial infarction

Research has focused more on symptoms, risk factors and treatment, than on individuals' experiences of illness and recovery after myocardial infarction (MI). Therefore, the aim of the study was to describe the experiences of present everyday life of women and men 4–6 months after MI and their expectations for the future. Semi-structured interviews were conducted with 20 women and 19 men from January 2000 to November 2001. Data were analysed with content analysis. Two themes, 'Managing consequences of MI' and 'Finding a meaning in what had happened', were generated. The first theme reveals that many of the patients had not established a stable health condition, even if symptoms and emotional distress had diminished over time. They had to manage health problems, lifestyle modifications, emotional reactions and changes in social life. The support from their social network encouraged them to move on. The second theme shows that patients also found positive consequences of what they had gone through, new life values and hopes in the future. The conclusions were that most of the patients moved on and began to regain a balance in everyday life, but some patients still struggled hard to find this balance. Those patients experienced large difficulties with managing their everyday life and felt a lack of support from their social network. Health professionals can be an important resource in helping patients in their adaptation to changes if they are more sensitive to patients' needs of support both in a short- and long-term perspective.     

Teaching and adaptation of patients with myocardial infarction

The role of teaching in facilitating adaptation were examined in 60 patients with myocardial infarction (MI) of working age (under 65 years). Recovery of three different patient groups were followed for one year at three times: at discharge and three months and one year after it. Data for evaluating the effects of the teaching program on the patients and their close relatives were collected by questionnaires from the patients at discharge and by interviewing the patients three months after discharge. Information on patients' recovery during the first year after MI was collected from patients' records. Impact of teaching was prominent on several outcome measures. Patients' knowledge of illness and care increased, they also perceived having received more information and support. The time devoted to exercise increased after myocardial infarction and amount of butter used on bread decreased in the follow-up state. No impact was observed on the outcome variables measuring patient's use of alcohol and smoking. Some of the impacts at the early stages of the convalescence were not lasting. After one year of MI patients had partly returned to their old life styles, for example some patients had resumed the smoking habit. Teaching of close relatives improved only slightly.     

Exploring the meaning of recovery following myocardial infarction

AIM: To explore the meaning of recovery from the perspective of patients who have had a myocardial infarction (MI) and their carers. METHOD: Constructivist grounded theory was used, incorporating individual and group interviews. Twenty-four cardiac support group members (15 patients and nine carers) participated in a group interview. Ten patients were individually interviewed six to nine months after MI. FINDINGS: Following an MI, participants felt different from how they were as a person' before the MI. Recovery was therefore an ongoing process that involved learning to live with that difference. 'Watchful insecurity' emerged as a core category in explaining recovery from the participants' perspective. Recovery was depicted as a series of 'peaks and troughs'. CONCLUSION: The individual nature of each person's recovery pathway can be used to develop acceptable and accessible services to support recovery following MI.     

Psychometric evaluation of 'The 25-item Sex after MI Knowledge Test' in a Swedish context

The patients' sexual life after a myocardial infarction is important for his/her quality of life. In spite of this, many patients are in doubt regarding their sex life after a myocardial infarction (MI) and the sexual information received, and counselling from health care providers has been seen to be insufficient. The purpose of this study was to evaluate the psychometric properties of 'The 25-item Sex after MI Knowledge Test' in a Swedish context. A convenience sample was recruited. The scale was translated into Swedish and completed by 79 former patients from The Heart and Lung Patients' National Association on two occasions, with an interval of 2 weeks. The scale was tested for face and content validity, internal consistency and test-retest reliability. The result in this study indicates that the instrument has good face and content validity and displayed a moderate internal consistency (alpha 0.61). The instrument showed some level of instability in test-retest reliability with 60% of the items presenting moderate or strong agreement between the test and retest. Further studies that use this instrument in larger and more diverse samples are thus needed.     

Long-term follow-up of health-related quality of life in patients with suspected acute myocardial infarction when the diagnosis was not confirmed

This study describes the outcome in terms of health-related quality of life (QL) five years after onset of symptoms in 397 patients with an initial suspicion of acute myocardial infarction (MI) but in whom the diagnosis was not confirmed. The patients were approached by means of a postal inquiry that comprised two questionnaires. The most pronounced impairment in health-related QL was expressed as decreased energy, whereas social life was the least affected area. The overall QL was very similar to that in patients who had a confirmed MI. Subsets of patients with impaired QL were those given the diagnosis of angina pectoris or possible infarction.     

'Grasp life again'. A qualitative study of the motive power in myocardial infarction patients.

Myocardial infarction is the most common cause of death in Sweden today and is responsible for approximately 30% of all deaths. The aim of this study was to obtain increased knowledge and understanding of what motive power is and how it affects the individual's rehabilitation and return to a functioning daily life. Thirteen patients, six females and seven males, who had experienced a myocardial infarction, aged between 39 and 72 years and with a minimum interval from myocardial infarction diagnosis of at least 12 months, were interviewed. Grounded theory was the method used for data collection and analysis, since the method is focusing on social processes and interaction. The analysis process identified motive power as a core category: zest for life. The participants expressed a desire and a longing to continue living. The participants' experiences of their disease as well as being discharged from hospital forced them to reorientation. Autonomy, the individual's own active decision-making, plays a significant role in this zest for life. Care for was identified as the support base for zest for life. As health-care professionals we must, at a very early stage on the ward, form an idea of what kind of patient we have in front of us.     

Cardiac rehabilitation program participation and outcomes after myocardial infarction.

Rehabilitation programs for myocardial infarction (MI) survivors are designed to alter survivors' self-care patterns and to improve long-term physical and psychological outcomes. The purpose of this study was to examine the relationship between participation in cardiac rehabilitation and health state; days of reduced activity; anxiety; depression; self-esteem; quality of life; and performance of exercise, diet, medication, stress-modification, and smoking-reduction self-care behaviors after MI. Interviews were conducted with 197 women and men 1 to 2 years after their initial MI to measure health state, mood, self-esteem, quality of life, and relevant self-care behaviors. Rehabilitation center records were reviewed to determine participation in rehabilitation programs. Rehabilitation participation was significantly associated with health state; days of reduced activity; self-esteem; quality of life; and performance of exercise, diet, and medication self-care. These findings suggest that participation in cardiac rehabilitation is a worthwhile intervention that facilitates recovery from myocardial infarction.     

The first 12 weeks following discharge from hospital: the experience of Gujarati South Asian survivors of acute myocardial infarction and their families

The period following discharge from hospital after an acute myocardial infarction (MI) is associated with vulnerability and psychosocial and physical morbidity for many survivors and their families. It is reported that people experience interpersonal, family and financial problems, self-care obstacles, work and physical difficulties. Culture and ethnicity undeniably influence the illness experience and the process of recovery and adjustment. This study investigated the perceptions of Gujarati survivors of acute MI and their families in Leicester, United Kingdom in the first 12 weeks following discharge in order to develop a profile of their health seeking beliefs and needs. Thirty-one interviews with 19 Gujarati MI survivors and their families (representing approximately 31 hours of dialogue) were analysed using grounded theory. Qualitative data revealed a period of vulnerability not only for survivors but also their families as they processed recent events and faced the future. Data analysis revealed nine interrelated themes describing the post-discharge experience for Gujarati survivors and their families. Data revealed that normal life was often markedly changed by the MI experience. Reflection, contemplation and resignation characterize this period of vulnerability. Overwhelmingly, data analysis revealed that the Gujarati culture, beliefs and customs influenced the recovery experience.     

Psychometric testing of the Chinese Mandarin version of the MacNew Heart Disease Health‐related Quality of Life questionnaire for patients with myocardial infarction in mainland China

Tools to measure the quality of life of Chinese myocardial infarction (MI) patients in mainland China are small in numbers. For this study, 210 Chinese patients with MI were recruited to examine the psychometric properties of the Chinese Mandarin version of the MacNew Heart Disease questionnaire. Thirty‐five participants managed to complete the retest after 2 weeks. The MacNew Heart Disease questionnaire had acceptable internal consistency, test–retest reliability and concurrent validity. The principal components analysis identified three factors which accounted for 56.6% of the variance. The MacNew Heart Disease questionnaire demonstrated good reliability and validity to be used as a health status measurement tool, and is ready for clinical use in the assessment of the quality of life of Chinese MI patients in mainland China.     

Clinical manifestations and life quality of patients with myocardial infarction during rehabilitation course with application of hypoxia in a pressure chamber

The subjects of the study were 85 men aged 49.7 +/- 6.4 years with myocardial scarring after myocardial infarction (MI). The purpose was to evaluate effects of rehabilitation measures on clinical manifestation of the disease and patients' quality of life (QL). The method of adaptation to periodical hypoxia in a pressure chamber was applied to the main group, and classic physical adaptation--to the control group. Positive clinical effect was achieved in 91% of patients in the main group, which was manifested by reduction of symptoms of the disease, as well as non-specific complaints. The study revealed concrete factors causing QL decline. Analysis of AMPI data showed that psychological profile parameters in MI patients were within normal limits. The patients on barotherapy displayed significant improvement of QL according to Medicosocial Questionnaire and Life Quality of a Stenocardia Patient Questionnaire immediately upon the rehabilitation course completion; no such result was achieved in the control group.     

Myocardial infarction may induce positive changes in life-style and in the quality of life

Eighty-four male patients with a mean age of 56.4 years were subjected to a semistructured interview 12-21 weeks after acute myocardial infarction. Twenty-eight individuals (group A) perceived a considerably or somewhat improved total life situation, 39 patients an unchanged (group B) and 17 patients (group C) a somewhat or considerably worsened total life situation. In all groups there were appreciable alterations with respect to stress on the job, physical activity and intake of fat/calories. Sixty per cent had reduced or quit smoking, and 19% had reduced their alcohol consumption. Fifty per cent of the patients perceived an increased gratitude at being alive. Similar recordings were found regarding "joy of life", value of hobbies, family and having good health. Concern associated with a reduced health status was experienced as the most distressing consequence of MI. There were no significant differences between groups A, B and C with respect to severity of the MI in contrast to the number of "psychiatric cases" (GHQ). The study concludes that it is considered important also to discover and reinforce possible positive changes after MI.