Coronary heart disease patients’ perception of their symptoms and sense of control before hospital discharge predicts their quality of life in the long term

Introduction: Recent intervention studies have attempted to address cardiac rehabilitation patients’ illness beliefs to improve care. However, these research findings are mainly limited to short-term behaviour changes such as return to work or attendance on rehabilitation programmes. Evidence available about what aspects of the patients’ illness beliefs would influence their long-term health outcomes in cardiac rehabilitation remains sparse. A more precise understanding of the relationship between specific illness beliefs that influence health status in the long term could provide clinicians with evidence to develop an effective individualised care approach and to promote quality of life. Objective: To examine the association between coronary heart disease patients’ illness beliefs and their quality of life 3 years following hospital discharge. Design: A cohort study of 300 patients who were admitted to hospital with a diagnosis of coronary heart disease; measuring their illness beliefs twice, before hospital discharge and nine months after discharge, using the Illness Perception Questionnaire. Patients’ demographics, illness characteristics and attendance at cardiac rehabilitation were also included in the multiple regression analyses. Outcome measures: Quality of life was measured using the Health Survey SF36v2 questionnaire with eight domains and two summary scores (physical and mental health) 3 years after hospital discharge. Results: Average age of enrolled patients was 65 years, 79% male, 50% acute myocardial infarction and 50% angina, 61% had no previous history of cardiac illness, 55% had index admission as emergency and 57% subsequently attended cardiac rehabilitation. Two multiple regression analyses were performed with each of the SF-36v2 physical and mental health summary scores as dependent variables. Analysis of baseline data showed that 43% of the variance in the physical health summary score at three years after index admission was accounted for by a perceived lower number of symptoms, belief that the illness was controllable, index admission as an emergency and no previous history of cardiac illness; 22% of the variance in the mental health summary score was accounted for by perceived lower number of symptoms and no previous history of cardiac illness. Analysis of data collected 9 months after discharge showed similar findings. Conclusion: Coronary heart disease patients’ perception of their symptoms and disease “controllability” are significantly associated with their quality of life 3 years after admission to hospital. Interventions designed to address patients’ sense of control and symptom management are likely to improve their quality of life in the long term