Recovery from a coronary event: Understanding the nature of the patient's journey

Abstract

<p><strong>Introduction:</strong> As new technology has improved the diagnosis and treatments of acute coronary syndrome (ACS), our understanding of how patients recover and return to their daily life is limited. The fast pace with which individuals move through the health care system has produced a new set of patient experiences for which systems and providers are unprepared. Life after ACS and current treatment may be very different from prior understandings of recovery after a heart attack. This study explored the trajectories of recovery following ACS and identified implications for effective care planning.</p> <p><strong>Methods:</strong> Qualitative interviews were conducted with 20 patients (men 11; women 9) (mean age 60 &plusmn; 10 years) at four time points over the six months following admission for ACS to elicit accounts, thoughts, and feelings about recovery. A grounded theory approach was used to code and analyze verbatim transcripts.</p> <p><strong>Results:</strong> ACS patients were compelled to assume many new responsibilities following diagnosis and treatment including understanding their condition, developing self care skills, managing care transitions and integrating the diagnosis and treatment into their lives. Most subjects described emotional and/or physical burdens in this process. Physical burdens included concerns about activity (80%), symptom management (65%), and incision care (10%); emotional burdens included uncertainty (90%), difficulty managing competing priorities (80%) and a sense of vulnerability (45%). Three patterns of recovery were identified: Seamless (15%) in which patients encountered few, if any, burdens, Burdened but manageable (35%) in which patients managed burdens with systems of care available, and Burdened requiring resources (50%) in which patients encountered burdens for which resources were necessary. While 11 subjects were referred for cardiac rehabilitation, 7 reported delays in participation. Only 36% of those referred reported appreciating benefits; others were concerned about timing and attention to individual concerns.</p> <p><strong>Conclusions:</strong> As providers plan care, they should consider the level of burden imposed by the diagnosis and prescribed regimen in relation to the internal and external resources available. Despite positive procedural results, these burdens have an important impact on the process and outcomes of recovery. Administrators should examine the availability and access of services to support patients during recovery.</p>