Heart patients ignoring doctors' orders

Wendy Vandermade is cautious about doing stressful things and goes to a cardiac gym three times a week. Picture / Greg Bowker

Some heart attack patients fail to give up smoking or take enough exercise because they fail to comprehend doctors' warnings about a repeat attack.

Others go to the opposite extreme, needlessly giving up work and all exercise because they fear the stress will trigger another heart attack.

These are all symptoms of what a new study diagnoses as a miscommunication between health workers and most of their heart patients.

Patients' changes in their lives after leaving hospital are driven more by their own ideas about their risk of another heart attack than by what doctors tell them.

The study, by Auckland University and Auckland City Hospital, found the patients' perceptions of their personal risk were unrelated to risk assessments using clinical measurements.

The researchers say this may arise from strong ideas formed soon after admission to hospital, the effect of mood, especially negative feelings about having another heart attack, and because health workers may be ineffective at communicating risk.

"Many doctors working in cardiac wards will not realise how inaccurate their patients' perceptions of future risk are," says the research paper in the latest Internal Medicine Journal.

One of the researchers, psychologist Dr Elizabeth Broadbent, said yesterday: "Patients need to know the risks associated with their condition and the treatment options so they can make informed healthcare decisions."

Understanding their future risks gave patients the motivation to accept aggressive treatments and change their habits, she said.

For the study, the answers of 79 heart attack patients to questionnaires on their perception of risk were compared with their clinical records.

Wendy Vandermade suffered a heart attack in 2003. The administration worker of Avondale in Auckland, now aged 51, said yesterday that after feeling unwell twice in two days she was taken to Auckland Hospital by ambulance. She has never smoked, has always been careful about her diet and is underweight, but has a family history of heart disease: four male relatives died of it in their 40s.

She takes a range of heart drugs, is cautious about doing stressful things, and goes to a cardiac gym for three sessions a week. The degree of blockage in her affected heart artery has declined markedly.

Mrs Vandermade's own risk assessment seems to buck the trend and coincide with her doctor's. "She's got a family history and she's working very hard to keep her risk down," said Dr Chris Ellis, her cardiologist and one of the researchers.

Mrs Vandermade said hospital staff gave her plenty of information about cardiac rehabilitation, including seven weekly talks. Supervised gym sessions at Green Lane Hospital were offered, followed by a referral to a cardiac rehabilitation gym.

"It's really good; they give you a lot of literature you can refer to ... At first you don't take it all in. It's important to have somebody with you who can take it in and talk to you later."