Abstract:
The acute coronary syndromes (ACS) are a common group of conditions that decrease blood flow in the coronary arteries, resulting in heart muscle damage. Due to advancements in treatment, many individuals survive acute coronary events and must adapt to living with coronary heart disease. A large number of patients however fail to adhere to treatment and recommended lifestyle changes, which results in further disability and complications. Empirical evidence has found that ACS patients’ illness perceptions and medication beliefs predict their functional outcomes. Furthermore the amount of damage patients perceive to have occurred to the heart can be assessed through drawings and can similarly predict outcomes. Although previous interventions to improve beliefs and behaviours in ACS patients have produced promising results, there are limitations in their clinical utility. Furthermore, no interventions have systematically attempted to improve ACS patients’ visual models of illness using drawings and animations. This study aimed to investigate the efficacy of a brief, visual, psychoeducational intervention to improve illness perceptions, medication beliefs and outcomes in ACS patients. 70 patients were randomized to receive the intervention or standard care only during hospitalization. The intervention incorporated animations depicting the pathology of ACS, resulting damage to the heart, as well as how medication adherence and behaviours can support recovery. Illness and medication beliefs, drawings, health behaviours and outcomes were assessed at baseline, post-intervention and seven weeks post-discharge. Patients who received the intervention had significantly increased treatment control beliefs, decreased medication harm beliefs, decreased concern about their heart medication and were more likely to report adherence as a healthy behaviour post-intervention. At 7-week follow-up, intervention patients maintained increased treatment control beliefs, but also reported longer timeline perceptions and attributed fewer symptoms to their heart condition. Changes in perception coincided with greater self-reported exercise and faster return to normal activities by intervention patients, although they did not report greater medication adherence or have lower cholesterol levels than the control group. All effects remained statistically significant when controlling for heart attack severity. These findings suggest that a brief, visual, psychoeducational intervention can improve illness and medication beliefs in ACS patients and result in faster return to normal activities, greater exercise levels and fewer symptoms. The intervention improves previous illness perception interventions with ACS patients as it can be administered in just 15 minutes at the patient’s bedside and is also well accepted and understood. The results support the clinical utilization of the intervention to enhance recovery in ACS patients.