Patients admitted to the hospital with obstructed heart arteries were three times more likely to experience complications in hospital if they felt they were not in control of their condition, according to an international study.
Persistent anxiety on its own appeared to have little effect on whether patients experienced complications.
Researchers examined 171 patients admitted to hospitals with acute coronary syndrome in the United States, Australia and New Zealand, following them for two years. Patients average age was 69, and 64% were men.
The researchers concluded that giving patients greater perceived control of their heart illness could reduce complications after ACS.
Sharon McKinley, RN, PhD, professor of critical care nursing at the University of Technology in Sydney, said coronary heart disease accounts for almost one in five deaths in the U.S. and Australia and leads to 1.76 million hospital admissions a year in the U.S.
The research team spoke to all participants at three, 12 and 24 months and gave them a free telephone number to call if they went to a hospital for suspected ACS symptoms. Experienced cardiovascular nurses trained in data abstraction for the purposes of the study then examined the patients records for a range of clinical characteristics and complications.
The anxiety and perceived control measures were obtained in face-to-face interviews when patients were enrolled in the study and by mailed questionnaires with follow-up telephone interviews at three and 12 months.
The researchers found that 15% of patients experienced complications in hospital following admission for ACS, mainly because of an abnormal heartbeat or reduced blood supply to the heart.
Half the patients were anxious at baseline and 56% at three months, with 37% categorized as persistently anxious after displaying anxiety at both points. Meanwhile, 58% had low perceived control; these patients tended to be younger with a higher body mass index and higher pulse rate on admission. Of the patients with persistent anxiety, 73% had low perceived control.
Patients with low perceived control over their heart conditions were 3.4 times more likely to experience in-hospital complications than were patients with high levels of control. The researchers found no difference in complication rates between patients who were persistently anxious and other patients.
“The findings that low perceived control, but not persistent anxiety, were predictive of in-hospital complications after ACS has two key implications for nursing practice and policy,” McKinley said. “Firstly, it may be possible for nurses to increase cardiac patients perception of control over their illness and secondly, increasing perceived control may reduce the risk of complications after ACS.”
The study appears in the October issue of the Journal of Advanced Nursing. The study abstract is available at http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2011.05933.x/abstract.