Edinburgh Napier University

  Introduction and background: Elective percutaneous coronary intervention (PCI) should reduce patients’ angina symptoms but thereafter it is critical that patients self-manage their coronary heart disease (CHD) (i.e. manage any angina symptoms, reduce cardiac risk factors and adhere to a pharmacological treatment regimen) to minimise disease progression and the need for further intervention. Contemporary healthcare aims to involve patients more in their care but support for them is necessary from healthcare professionals in order to achieve the best possible health outcomes. Support from family and friends is also beneficial. Research suggests that self-management of CHD after elective PCI is poor and that patient support may be ineffective. This is poorly understood. This research is a sub-study of a larger study exploring patients’ CHD self-management after PCI.

Aim: To understand and describe the support needs of patients in relation to their self-management of CHD after elective PCI. The research questions were as follows:
a) Ascertain how patients self-managed their CHD and explore what support they received from healthcare professionals and from family / friends
b) Explore where they sought support to aid their CHD self-management

Methods: This mixed methods study used an explanatory, sequential design and recruited a non-probable sample (n=93) approximately three months after the elective PCI procedure. The study was conducted in two phases. In phase one quantitative data were collected from participants using a validated self-administered survey tool. Quantitative data were subject to univariate and bivariate analysis. Phase 1 findings informed the purposive sampling for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualitative data were analysed using thematic analysis.

Results: Participants had a mean age of 66.25 years (SE±10.56), were mostly male (n=70/75.3%) and Caucasian (n=80/86%). Most lived with someone (n= 61/ 72.4%) and a minority had a carer (n=15/17.2%). Results were divided into two main categories: healthcare provider support and social support. In the time from PCI to data collection 38.7% (n=36) participants had been admitted to hospital and 69.8% (n=65) had seen their general practitioner (GP) at least once. Those who had been hospitalised were less likely to reduce cardiac risk factors (2= 28.627, p=0.095) but they were more likely to know how to self-manage recurring angina symptoms (2 = 4.170, p=0.841). GP support had no statistically significant relationship with modification of cardiac risk factors nor participants’ knowledge of effective angina management (p=0.152). All participants were invited to attend cardiac rehabilitation and 25.8% (n=24) attended. Gaining support from cardiac rehabilitation did not make participants more likely to modify cardiac risk factors compared with those who had not attended rehabilitation (r=-0.069, p=0.527). Qualitative findings indicated that support from healthcare professionals was lacking for CHD self-management:
“He [GP] told me to just take it easy but he said ‘I reckon that you will know yourself what to do and what not to do” (P 80).

“After it’s all over that’s the hospital done their job but there’s nobody really there to support you...they haven’t got time to sit and talk...maybe if more time could be spent but there’s not the resources now is there?” (P57).

“I just felt I didn’t get enough advice. Anything I felt I needed to find out about I found out by myself from the ‘net [internet]” (P91).

Twice as many participants who lived with someone did not know how to effectively manage angina symptoms compared to those who lived alone. No relationship was found between the living arrangements of participants and their modification of cardiac risk factors. Qualitative findings suggested that although participants appeared to have support from family and friends it was difficult for them to identify what support was actually afforded them with many citing that they found it difficult to have meaningful conversations about their heart condition.
“There’s not really any other support...You just have to get on with it yourself” (P88).

Conclusion:
Clinical guidelines and policy statements advocate that healthcare professionals should provide individualised support to patients in their CHD self-management post-PCI and yet this seemed to be seriously lacking from hospital personnel, GPs and cardiac rehabilitation teams. There seemed to be a ‘social disconnection’ between participants and their friends and family as relationships with these people were considered absent or unhelpful in supporting self-management. Strategies to support patients self-manage their CHD after PCI needs to be person-centred to ensure individualised needs are met.