Factors related to rehabilitation after first acute myocardial infarction

The major objective of this research has been the investigation of associations between aspects of rehabilitation after myocardial infarction and a number of psychological factors. The influence of medical, social and occupational factors, was also studied. The first chapter explains what a coronary heart disease is. The second chapter shows that although most patients surviving a heart attack are expected by cardiologists to restore their pre-illness level of activity in most areas of life within 3-4 months of leaving hospital, many of them do not do so. Chapters 3 and 4 review the literature in which explanations are put forward for this discrepancy between the expectations of cardiologists and the actual behaviour ofpatients. It appears that this discrepancy can often not be explained simply in terms of physical, cardiac disability or unsuitable occupational demands. It has frequently been proposed that psychological factors play an important role in determining the degree of success of the rehabilitation process. Such reasoning however, has usually been based on theoretical considerations, subjective impressions or clinical observations of small samples rather than on the findings of well controlled studies. The fifth chapter specifies the research objectives and dependent and independent variables. The following seven aspects of the rehabilitation were studied as dependent variables: Return to work, Resumption of physical activity at Work, Resumption of mental load and responsibility at work, Resumption of daily number of hours at work, Resumption of sexual activity, Resumption of driving and change in the pre-illness life-style. Each one of the seven aspects is investigated separately in chapters 8 to 14. The associations between the dependent and independent variables were analysed in two follow-ups four and ten months after leaving hospital. The analyses were carried-out on data obtained from 183 patients. The results (which are summarised in the end of each chapter) show that by four months, 62% of the patients had returned to work. Of these patients 53% fUlly resumed their physical activity at work, 74% fully resumed their mental load and responsibility at work and 62% fully resumed their daily number of hours at work. By ten months the respective figures were: 84%, 65%, 77% and 78%.By four months 61% of the patients fully resumed their sexual activity, 78% fully resumed their driving and 26% reported no changes in their life-styles. At ten months the respective figures were: 57%, 78%, and 26%.The independent variables found to be most significantly related to the rehabilitation criteria were: Severity of the illness, Physical disability, Anxiety level during first two days in hospital, Perception of causes of the illness, advice given by consultants GPs or wives regarding whether or not to resume work and the level of general well-being expressed by the patients. It is concluded that many of these variables may prove to be of a potential usefulneSS for purposes of early detection of patients likely to fai1 or delay their rehabilitation.Finally, the advantages and disadvantages and the major research conclusions are discussed in chapter 16