Patients lack individualized support after elective PCI
General practitioners (GPs), hospital personnel and cardiac rehabilitation teams seriously lack individualized support to patients in their self-management of coronary heart disease (CHD) after undergoing elective percutaneous coronary intervention (PCI) despite clinical guidelines and policy statement encouraging this, reports a study presented at the Singapore Prevention & Cardiac Rehabilitation Symposium (SPCRS) 2017.
“There seemed to be a ‘social disconnection’ between participants and their friends and family as relationships with these people were considered absent or unhelpful in supporting self-management,” said researchers.
This research is a substudy of a larger mixed-methods study that used an explanatory, sequential design and recruited a convenience sample (n=93) 3 months post-PCI. It was conducted in two phases. [J Geriatr Cardiol 2016;13:393–400]
In phase 1, quantitative data were collected from participants using a survey tool, and these data were subject to univariate and bivariate analyses. Phase 1 findings informed the purposive sampling for phase 2, where 10 participants were chosen from the original sample for an in-depth interview. Qualitative data were analysed using thematic analysis. [SPCRS 2017, abstract N-27]
Most of the participants (mean age 66.25 years; 75.3 percent male; 86 percent Caucasian) lived with someone (72.4 percent) and a minority had a carer (17.2 percent). Results were divided into two: healthcare provider support and social support.
Thirty-six participants (38.7 percent) had been hospitalized and 65 (69.8 percent) had seen their GP at least once in the time from PCI to data collection. Those who had been admitted to the hospital had lesser chance of attenuating cardiac risk factors (p=0.095), but they were likely to be better at self-management of recurring angina symptoms (p=0.841).
Statistically, GP support was not significantly associated with modification of cardiac risk factors or participants’ knowledge of effective angina management (p=0.527).
All participants were invited to attend cardiac rehabilitation, but only 24 patients (25.8 percent) attended. Interestingly, modification of cardiac risk factors was not substantially different between participants who attended cardiac rehabilitation and those who did not (p=0.527).
Qualitative findings from in-depth interviews revealed that healthcare professionals lack support for CHD self-management. One participant even admitted to not getting adequate guidance: “I just felt I didn’t get enough advice. Anything I felt I needed to find out I found out by myself from the internet.”
Another one suggested that hospital personnel lacked time to counsel patients about CHD self-management: “After it’s all over, there’s nobody really there to support you… They haven’t got time to sit and talk… Maybe if more time could be spent but there’s not the resources now is there?”
Furthermore, twice as many participants who lived with someone still failed to amply manage angina symptoms compared to those who lived alone. Qualitative findings suggested that patients found it difficult to identify which support was actually afforded them, even as they appeared to have support from family and friends.
Some participants said that they found it challenging to have meaningful conversations about their heart condition. “There’s not really any other support… You just have to get on with it yourself,” said one patient.
“Strategies to support patients self-manage their CHD after PCI needs to be person-centred to ensure individualized needs are met,” researchers said.