Why Illness Perceptions Count in Heart Health
Half of all patients hospitalised with a serious heart condition will make mistakes with their medications within a month of checking out of the hospital.
Half of all patients hospitalised with a serious heart condition will make mistakes with their medications within a month of checking out of the hospital, says the latest research from Vanderbilt University Hospital and Brigham and Women's Hospital in Boston.1 To investigate this issue, Clare Moloney, a Health Psychology Specialist with a focus on cardiovascular health, explains the ‘patient perspective’ and tells us why – and how we can help to tackle this issue.
The cost of poor heart health
The economic impact of Coronary Heart Disease (CHD) in the UK alone is huge, costing taxpayers an average of £1.7 billion each year. Loss of productivity has even greater consequences: more than £3.9 billion in 2006, with 65% attributed to death and 35% to CHD related illness.2
There is evidence to demonstrate that adherence to prescribed medication in conjunction with lifestyle modification greatly improves patient outcomes.3 Conversely, non-adherence has the opposite effect. So it is important to understand what holds patients back from taking their medications as prescribed.
Discovering what really drives patients
The OneHeart patient programme, which is now available in Bristol hospitals, was developed to improve adherence and support patients with Acute Coronary Syndrome (ACS) - which is an umbrella term used for patients who have had a heart attack or episode of unstable angina.
Being able to research the real issues around non-adherence in ACS, and then inform the design and development of the OneHeart programme revealed insights into how patients cope with this condition, and how we can aim to support them. As part of this programme a literature review was commissioned, alongside patient and Healthcare Provider (HCP) research, which uncovered the real drivers of non-adherence in this patient group.
Adherence challenges in heart health - revealed
The research uncovered some interesting findings, and as with all illnesses there were a variety of patient perceptions and beliefs that led to non-adherence:
- “I was only in hospital for a couple of days, it can’t be that bad”
Although the implications of having a heart condition are very serious, advances in treatment means that many patients may now only spend a short time in hospital following an episode, leading to a misunderstanding about the seriousness of the condition.
- “Well, that’s it for me…”
Research with OneHeart found that patients who feel a lack of control following hospitalisation and diagnosis could be ‘fatalistic’, taking the view that nothing can help their condition: either medical treatment or lifestyle changes.
- “Who are you to tell me?”
Other patients may find it hard to accept their diagnosis (particularly those who are largely asymptomatic) and therefore find it hard to accept their diagnosis or choose to rebel against the advice given as a way of avoiding facing the 'truth' about what has happened to them.
- "I was so shocked, everything’s just a blur”
For many people, receiving information at hospital discharge or in the very first recovery phases is too early.4 Patients who have very recently had a Myocardial Infarction (MI) or received a CHD diagnosis may not be able to absorb important information fully due to post-traumatic stress or an emotional response to their illness. This can impair their cognitive ability to the extent that they cannot understand how to manage their medicine and lifestyle changes.5
Helping patients get improved outcomes
To empower a patient to better self-manage their condition and achieve better long-term health, these underlying beliefs must be targeted. To change their behaviour, the key thing to do initially is to understand the current beliefs patients hold in relation to their illness and their treatment. Then you can work to appropriately increase their understanding about their condition by providing targeted information and getting them to objectively evaluate the reasons they hold these beliefs.
Most patients with chronic conditions must come to terms with their diagnosis, and that they are likely to be on medication ‘for the rest of their lives’, which can lead to grieving as they come to terms with the ‘death of wellbeing’.6 Other interconnected psychological effects include depression and anxiety, as well as distress at time spent away from work.
OneHeart encourages patients to seek social support to help them through this process of readjustment, and provides information to share with family and caregivers, as well as giving patients strategies on how to begin to widen their support circle.
Family and friends can play a vital role
Caregivers and family have a key role to play, not only through offering support, but also by influencing beliefs. Poor social support has been linked with greater risk of recurrent cardiac events following ACS,7 while positively perceived social support leads to better long-term outcomes after MI.8 In the case of MI, congruent positive beliefs between the patient and their partner predict better outcomes and recovery.9
How HCPs can make a difference
HCP’s can make a real difference in addressing patient’s unhelpful beliefs about their medication. I’d say to check levels of understanding in recently diagnosed and discharged patients who may not have been able to ‘take everything in’ when they are first told. Then, further along the line, try to understand how the patient is feeling about their treatment and condition to ensure they still understand the long-term nature of ACS and the importance of appropriate adherence to help them enjoy not only day to day quality of life, but hopefully a lengthier life, too. The positive message for patients is that they can have a positive effect on their own health.
1. Annals of Internal Medicine, July 3rd 2012, 2. British Heart Foundation, 2010, 3. De Backer et al., 2003, 4. Royal College of Physicians, 2010; Timmins, 2005, 5. Timmins, 2005, 6. Royal College of Physicians, 2010, 7. Lett, Blumenthal, Babyak et al., 2005, 8. ibid. 2007, 9. Figueiras & Weinman, 2003
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