Role of patients' view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study

Abstract

Objective: To examine whether patients' initial perceptions of their myocardial infarction predict subsequent attendance at a cardiac rehabilitation course, return to work, disability, and sexual dysfunction. Design: Patients' perceptions of their illness were measured at admission with their first myocardial infarction and at follow up three and six months later. Setting: Two large teaching hospitals in Auckland, New Zealand. Subjects: 143 consecutive patients aged under 65 with their first myocardial infarction. Main outcome measures: Attendance at rehabilitation course; time before returning to work; measures of disability with sickness impact profile questionnaire for sleep and rest, social interaction, recreational activity, and home management; and sexual dysfunction. Results: Attendance at the rehabilitation course was significantly related to a stronger belief during admission that the illness could be cured or controlled (t=2.08, P=0.04). Return to work within six weeks was significantly predicted by the perception that the illness would last a short time (t=-2.52, P=0.01) and have less grave consequences for the patient (t=-2.87, P=0.005). Patients' belief that their heart disease would have serious consequences was significantly related to later disability in work around the house, recreational activities, and social interaction. A strong illness identity was significantly related to greater sexual dysfunction at both three and six months. Conclusions: Patients' initial perceptions of illness are important determinants of different aspects of recovery after myocardial infarction. Specific illness perceptions need to be identified at an early stage as a basis for optimising outcomes from rehabilitation programmes. Patients' beliefs about their illness seem to influence recovery and rehabilitation on discharge from hospital Patients' ideas about their illness cluster around five cognitive dimensions: identity, cause, time line, consequences, and beliefs about cure or control In this study a belief that the illness could be controlled or cured was related to subsequent attendance at a cardiac rehabilitation course. Perceptions that the illness would last a long time and have serious consequences were associated with a longer delay before returning to work The early identification of illness perceptions could improve the outcome of cardiac rehabilitation programmes