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. Key messages: 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