Edinburgh Napier University

  Background
Coronary Heart Disease (CHD) is a major cause of ill health in Scotland and one of the main methods of symptom management for this disease is Percutaneous Coronary Intervention (PCI). This treatment relieves the symptoms of the disease but does not halt the disease process, therefore, there is a need for the individual post PCI to adhere to secondary prevention information. With the advances in treatment and reduced length of inpatient stay, access to health professionals for support and information is a challenge. Research confirms patients’ inability to access support increases the risk of them experiencing negative emotions which impair the individual’s ability to adhere to secondary prevention. This study sought to explore the lived experience of how CHD patients feel they obtain emotional support post PCI.

Methods
A qualitative interpretative phenomenology approach was used and data were collected using individual semi-structured participant interviews. This method of data collection ensured the voice of the participant was shared. A purposive sample of 7 individuals diagnosed with CHD and treated with PCI within the past 12 months was recruited from a formalised phase IV gym-based exercise programme delivered in a community setting in one region of Scotland. The participants were mostly male with an average age of 47 years and 30% had comorbidities. Participants had undergone PCI between three and twelve months previously either as an intervention to control angina symptoms or to relieve the coronary artery obstruction caused by a myocardial infarction (heart attack). Data were analysed using an interpretive approach.

Findings
The methodological approach of analysis identified three overarching themes; PCI is not a fix, loss if identity and cardiac rehabilitation is a safety net. The use of Leventhal’s self-regulation model of illness perceptions contributed to understanding two main groups of emotions are experienced post PCI treatment. The emotions of fear, anxiety and disappointment are experienced in relation to the physical body and found to be due to the non-curative nature of the PCI. For the majority, this results in a fixation with diagnostic tests as a means of emotional support. The emotions of frustration, embarrassment and guilt are experienced in relation to a perceived loss of identity. For some a focus on lifestyle modification is a means of emotional support, for others, talking to others similar to themselves offers reassurance and for three male participants, risk-taking behaviour is exhibited as a means of taking back control. For the majority, cardiac rehabilitation provides an educational environment but fails to offer emotional support for individuals who do not trust the PCI treatment and have existing co-morbidities or experience complex social circumstances.

Conclusions
This is the first study to explore participant’s views of how age, gender, social circumstances and the presence of comorbidities affect emotions after the treatment of the PCI. Age and gender were associated with the experience of negative emotions related to the CHD diagnosis and non-curative treatment of the PCI. For some males, this resulted in risk-taking behaviour and for others, a fixation with diagnostic tests. For individuals who do not trust PCI as a treatment and have existing co-morbidities or females experiencing complex social circumstances, the information received within the current cardiac rehabilitation pathway is not sufficient to reduce negative emotions.