Intensive Patient Education Primes Care-Seeking Attitudes for Acute MI

Heart attack survivors who participated in an psychoeducational intervention reported changes in attitude and beliefs around seeking care if they were to again experience acute myocardial infarction (MI) symptoms, a randomized trial from Hong Kong showed.

Patients randomized to the intervention group, consisting of five in-person nurse-led sessions in which they discussed and interacted with educational videos in small groups, reported greater positive changes in their attitudes and beliefs toward care-seeking on the Acute Coronary Syndrome Response Index questionnaire (Chinese version) at 3 and 12 months compared with controls who participated in four weekly nurse-led didactic lectures about acute MI and care seeking, reported Polly Li, PhD, of the University of Hong Kong School of Nursing, and colleagues.

Of note, knowledge about acute MI symptoms was not significantly different at the 3-month and 12-month marks, they noted in JAMA Network Open.

Nevertheless, the hope is that more positive care-seeking attitudes might translate into quicker treatment and revascularization, and ultimately further improvements in clinical outcomes after heart attacks.

“Longer-term follow-up to evaluate actual care-seeking behavior and clinical outcomes in patients with acute MI is warranted to determine the sustained effects of this intervention,” Li and colleagues acknowledged.

They noted that prehospital delays in acute MI have persisted for years, whereas significant improvements have been made in reducing the door-to-treatment time. Media campaigns and counseling interventions have generally not been able to reduce prehospital delays.

Previous studies have found women in particular to be slower to seek medical care for heart attacks.

On top of that, the COVID-19 pandemic has been associated with longer ischemia times and more late-presenting patients with ST-segment elevation MI.

In this study, the narrative-based psychoeducational intervention included teaching the skills of symptom recognition, handling the emotional responses upon symptom onset, overcoming perceived barriers, and mastering the decision-making process.

The novel intervention was tested from 2018 to 2021 in a trial that included 608 heart attack survivors recruited from four hospitals in Hong Kong. Mean age was 67 years, 77% were men, and all were of Chinese ethnicity.

Participants were randomized to the psychoeducational intervention or didactic teaching. The two groups were well-balanced demographically, except that the intervention group had proportionally more women.

Overall adherence was 91.0% for the intervention group and 84.2% for the control group.

“Unlike previous studies that targeted the general public or other community-dwelling individuals, we targeted those patients who had a prior episode of acute MI to prepare them to respond to a recurrent attack. These patients would likely perceive the intervention to be more relevant to them and, thus, be more receptive toward the intervention,” Li and colleagues noted.

It remains to be seen if such an intervention is feasible in a busy clinical setting; an online format could be pursued and tested, the team suggested.