Effects Of A Self-help Pack On Patients Who Have Had A Myocardial Infarction

Background: In the West, a growing number of patients who have had amyocardial infarction are referred to or enrolled in cardiac rehabilitation programs,which not only reduce morbidity and mortality but also promote quality of life aswell as physical and psycho-social status. But, in many parts of the world, especiallyAsia, many hospitals do not offer such programs after their discharge from thehospital, and even if they do many patients find it difficult to attend.Objective: To compare the effectiveness of a home-based self-help pack (HP)versus usual care for patients who have had a myocardial infarction, 136 patientswere randomly allocated to the treatment group (HP and usual care) and thecontrol group (usual care)Methods: Patients were randomized before commencing the study and makingbaseline measures. For subjects in the treatment group, the researcher introduced theHP to the patient and their partner/family one or two days prior to discharge fromhospital. At the initial meeting the correct way to do the exercises and relaxation wasdemonstrated to the patient. The patient's partner/family member was encouraged tojoin in with the program and help the patient to adhere to it. The researcher checkedon the progress of the patient on exercise and relaxation and risk factors reductioncontrol, answer any questions that the patient had and made suggestions to thepatient to overcome difficulties to promote adherence by phone. Subjects in thecontrol group received usual care, including discharge education for exercise andlifestyle changes in CHD before discharge. They did not receive the protocol ofphone calls after discharge. The effects were measured by phone in the 3rd weeks,6th weeks and 12th months after their discharge from the hospital. The instrumentsand outcome measures included: psychological distress (Hospital Anxiety andDepression Scale, Rosenberg Self-Esteem Scale, General Health Questionnaire);health-related quality of life (SF-12 Health Survey); lifestyle changes (exercise adherence and rate of smoking); clinical aspects (readmission rate after discharge,rate of visits to GPs for cardiac reasons and number of episodes of chest pain).Results: 122 subjects finished the whole data collection, 63 patients in thetreatment group and 59 patients in the control group. Patients who received the HPas well as usual care had better health outcomes than those who received usual carealone. These outcomes included: less anxiety and depression, better physical activityexercise, and a lower use of health services, including fewer GP consultations and alower readmission rate. However, the differences of self-esteem and quality of lifebetween the intervention group and control group were insignificant.Conclusion: The finding of this study demonstrates that the home-based self-helppack may benefit the acute myocardial infarction patients in many aspects andindicates that it might be worth offering such a self-help package to all patients withacute myocardial infarction.