Broadbent E, Petrie K J, Ellis C J, Anderson J, Gamble G, Anderson D, Benjamin W
Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Intern Med J. 2006 Oct;36(10):643-7. doi: 10.1111/j.1445-5994.2006.01150.x.
Accurate perceptions of future cardiac risk are important to ensure informed treatment choices and lifestyle adaptation in patients following myocardial infarction (MI). The aim of this study was to investigate whether risk perceptions of patients with MI were accurate compared with an established clinical risk model.
Seventy-nine consecutive patients with acute MI admitted to the Coronary Care Unit, Auckland Hospital, completed a questionnaire assessing risk perceptions. Clinical data were used to calculate patients' Thrombolysis In Myocardial Infarction (TIMI) risk scores, a validated predictive model of prognosis. The main outcome measures were the associations between perceived risk, TIMI risk scores and troponin T.
Patients' risk perceptions showed no correlation with thrombolysis in myocardial infarction risk scores (r = -0.06; P = 0.61) or with troponin T (r = -0.07; P = 0.53). Patients' risk perceptions were not significantly associated with age or sex, and were not significantly higher in those who had experienced a previous MI, a family history of coronary heart disease, diabetes or smokers. Higher perceived risk was significantly associated with a number of illness perceptions, including worse consequences of the MI and lower beliefs in the benefit of treatment. Patients who overestimated their risk were more anxious than other patients (F(2, 73) = 22.97; P = 0.0001).
Patients with MI ideas about their personal risk of future MI are not congruent with their clinical risk assessments. Inpatient hospital care appears to be unsuccessful in communicating prognosis effectively to patients. Improving the accuracy of risk perceptions may help decrease unnecessary cardiac anxiety and invalidism in some patients and prompt risk-reducing behaviours in others.
准确认识未来心脏风险对于确保心肌梗死（MI）患者做出明智的治疗选择和调整生活方式至关重要。本研究的目的是调查与既定的临床风险模型相比，MI患者的风险认知是否准确。
连续79例入住奥克兰医院冠心病监护病房的急性MI患者完成了一份评估风险认知的问卷。临床数据用于计算患者的心肌梗死溶栓（TIMI）风险评分，这是一种经过验证的预后预测模型。主要结局指标是感知风险、TIMI风险评分与肌钙蛋白T之间的关联。
患者的风险认知与心肌梗死溶栓风险评分（r = -0.06；P = 0.61）或肌钙蛋白T（r = -0.07；P = 0.53）均无相关性。患者的风险认知与年龄或性别无显著关联，在有既往MI史、冠心病家族史、糖尿病或吸烟者中也无显著升高。较高的感知风险与多种疾病认知显著相关，包括MI的更严重后果和对治疗益处的较低信念。高估自身风险的患者比其他患者更焦虑（F(2, 73) = 22.97；P = 0.0001）。
MI患者对其未来MI个人风险的认知与其临床风险评估不一致。住院治疗似乎未能有效地向患者传达预后信息。提高风险认知的准确性可能有助于减少一些患者不必要的心脏焦虑和残疾，并促使其他患者采取降低风险的行为。
