Perception of cardiovascular risk following a percutaneous coronary intervention: A cross sectional study
Introduction
Over the last two decades, there has been a rapid growth in interventional cardiology procedures, particularly percutaneous coronary intervention (PCI) for the treatment of stenotic coronary arteries (Eagle et al., 2008, Fernandez et al., 2006). This is the case in both the developed world and emerging economies, such as Thailand, India and China (Gaziano et al., 2010, Montalescot et al., 2008). Technological advances in PCI have led to an improvement in short- and long-term outcomes for coronary heart disease (CHD). Despite the well established benefits of risk factor modification CHD individuals often fail to change adverse behaviours (Fernandez et al., 2006, Goulding et al., 2010) and there is a reciprocal relationship between risk perception and adaptive behaviours (Brewer et al., 2004). A failure to accurately perceive risk or acknowledge consequences of behaviour can alter an individual's actions (Furze et al., 2003, Smith et al., 2006).
Factors, such as a less invasive approach of PCI for coronary artery revascularisation, the brevity of hospitalisation and the lower rates of morbidity compared to coronary artery bypass grafting (CABG) (Shirai et al., 2004), may result in individuals underestimating the significance of CHD. The potential perception of “being cured” has led to a failure in initiating lifestyle changes that could reduce the risk of a subsequent cardiac event (Eastwood, 2001, Holmboe et al., 2000). In addition, the short time spent in hospital means that it is hard for health professionals to spend time in providing education and support as it is often assumed that there is an increased receptivity to information based upon an acute event (Fernandez et al., 2006).
Section snippets
Cardiovascular risk-balancing actual and perceived risk
The mortality gains in CHD mean that many people are living longer with a chronic illness, requiring risk factor modification. Individuals with PCI are at risk of subsequent cardiac events (Fernandez et al., 2006). Inspite of this risk, individuals with a previous diagnosis of heart disease, experiencing symptoms of a heart attack, delay as long in presenting to the emergency room as those experiencing their first acute myocardial infarction (AMI) (Dracup et al., 2009, Dracup and Moser, 1997,
Aim
To investigate the perception of a cardiovascular event by examining the level of agreement between individuals with CHD views of their actual and perceived risk.
Methods
Patients diagnosed with CHD presenting for an angiogram and/or percutaneous coronary intervention at a tertiary referral setting in metropolitan Sydney, Australia were invited to participate in the Actual and Perceived Risk in Percutaneous Coronary Angiogram/Angioplasty (APRICA) Study. The aim of this study was to identify individuals at high risk for subsequent cardiovascular events. Eligibility for the study included those individuals undergoing elective, emergent and rescue procedures.
Results
We recruited 220 participants between March 2006 and August 2007. We estimate that this sample represented 31% of procedures undertaken during the study period. Of those potential participants screened, 78% met the study inclusion criteria. The most common reason for ineligibility was insufficient English language literacy to complete study instruments. Logistical issues such as research staff being unable to interview participants prior to discharge, and patients feeling unwell were major
Discussion
The risk factor burden of participants in this study is comparable with other published series (Fernandez et al., 2006). This study confirms the observations of other investigators who describe poor congruence between actual and perceived cardiovascular risk (Goldberg et al., 2002, Weinstein, 1989). Further, many individuals commonly hold erroneous beliefs regarding their health conditions (Furze et al., 2003, Furze et al., 2002). Of note there was an increased congruence between actual and
Conclusions
The low correlation between the risk factor burden and how individuals perceive this risk is of concern. Further, the lack of reliable and valid instruments to assess risk is an important area for future investigation given the challenges and subjectivity in appraising personal risk. Investigating strategies to increase the congruence between actual and perceived risk is likely to be an important strategy in implementing effective secondary prevention strategies.
Conflict of interest
None.
Funding
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2016, Patient Education and CounselingCitation Excerpt :Cure perceptions did not differ by ACS type or GRACE mortality risk score, contrary to expectations. A study of 220 patients hospitalized for PCI in Australia found that actual and perceived cardiovascular risk only weakly correlated [41]. Given the declines in length of ACS hospitalizations over the past few decades [42], we had expected shorter hospital stays to be associated with perceiving oneself cured; we found the opposite, perhaps because length of stay was strongly confounded by receipt of coronary revascularization.
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