Role of patients' view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study.

OBJECTIVE

To examine whether patients' initial perceptions of their myocardial infarction predict subsequent attendance at a cardiac rehabilitation course, return to work, disability, and sexual dysfunction.

DESIGN

Patients' perceptions of their illness were measured at admission with their first myocardial infarction and at follow up three and six months later.

SETTING

Two large teaching hospitals in Auckland, New Zealand.

SUBJECTS

143 consecutive patients aged under 65 with their first myocardial infarction.

MAIN OUTCOME MEASURES

Attendance at rehabilitation course; time before returning to work; measures of disability with sickness impact profile questionnaire for sleep and rest, social interaction, recreational activity, and home management; and sexual dysfunction.

RESULTS

Attendance at the rehabilitation course was significantly related to a stronger belief during admission that the illness could be cured or controlled (t = 2.08, P = 0.04). Return to work within six weeks was significantly predicted by the perception that the illness would last a short time (t = 2.52, P = 0.01) and have less grave consequences for the patient (t = 2.87, P = 0.005). Patients' belief that their heart disease would have serious consequences was significantly related to later disability in work around the house, recreational activities, and social interaction. A strong illness identity was significantly related to greater sexual dysfunction at both three and six months.

CONCLUSIONS

Patients' initial perceptions of illness are important determinants of different aspects of recovery after myocardial infarction. Specific illness perceptions need to be identified at an early stage as a basis for optimising outcomes from rehabilitation programmes.