Behaviour change after percutaneous coronary intervention

A recent study of behaviour change was undertaken in patients who had undergone percutaneous coronary intervention (PCI).

This procedure, which includes coronary angioplasty and insertion of stents, is a relatively new treatment. Coronary heart disease in PCI patients is often at an early stage. Thus, secondary prevention is particularly important for this group. Effective lifestyle modification can improve outcomes following PCI. Unfortunately, PCI patients appear to be less likely than other cardiac patients to change risk behaviours. Improved well-being after the procedure and a short stay in hospital often lead them to believe that lifestyle change is not necessary. PCI can produce immediate benefits, but it does not affect the underlying process of atherosclerosis that may create future occlusions.

Patients were recruited from The Royal Melbourne Hospital, St Vincent's Hospital and Melbourne Private Hospital. Structured interviews were conducted by telephone within two weeks of the PCI and again after six months. One focus of the study concerned physical activity. Anxiety, fear and depression can reduce the uptake and maintenance of physical activity after a cardiac event. Our study found that patients who were anxious soon after their procedure were significantly less likely to be physically active at follow-up. These findings highlight the need to identify such patients early to address their emotional problems.

Another focus of this study concerned patients' preferences for health education. Results showed that PCI patients were more likely to nominate cardiac rehabilitation program staff as their preferred source of information. Not surprisingly, patients who preferred alternatives to group cardiac rehabilitation were significantly less likely to attend rehabilitation. Other preferred sources were physicians, with the cardiologist being most commonly nominated as the best source of heart disease information. However, the general practitioner was more likely to be preferred as a source of information about lifestyle change. A minority of patients expressed a preference for self-education. It is clearly important to cater for patients who prefer individual rather than group approaches to secondary prevention.