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Head Rules the Heart

The ideas people have about heart attacks alter how rapidly they recover from having one, according to an Auckland School of Medicine study, which suggests patients' beliefs are more important than medical factors in directing the recovery process after a myocardial infarction.

Although recent advances in treatment have increased survival rates, only small gains are being made in improving rehabilitation once patients have left hospital. Many patients do not return to work, though they may be physically capable of doing so, and others have difficulty in returning to their previous level of sexual or social functioning.

Research has shown patients organise their thoughts about physical illness, how long the illness will last, what caused the illness, what the consequences of the illness will be for them, and how the illness is cured or controlled.

The idea that the patients' personal beliefs about their illness while in hospital relates to their attendance at a rehabilitation programme, the speed of return to work and the resumption of normal activities is the subject of the study, thought to be the first of its kind, and carried out collaboratively with researchers from Guy's Medical School in London.

Results of the study show patients who believed their illness could be controlled or cured were more likely to attend rehabilitation programmes. Furthermore, patients who returned to work within six weeks tended to believe that their illness would last a short time and have only a few personal consequences. Patients' initial perceptions of their illness seem to be important in determining recovery and could be used to improve current rehabilitation programmes.

Principal investigator Dr Keith Petrie, a senior lecturer from the department of psychiatry and behavioural science, says the study has important implications for cardiac rehabilitation.

The assessment of illness perceptions may have a valuable role in identifying which patients are likely to benefit from rehabilitation programmes as they are currently structured. Patients who perceive that their heart disease has little hope of being controlled may benefit from strategies targeted to change this perception before attending rehabilitation programmes.