RESUMO
PURPOSE: It is important for middle-aged patients who have undergone acute treatment for coronary artery disease to voluntarily improve their lifestyle and risk factors based on their recognition as patients with chronic diseases. This study conducted individual education to improve risk factors and tried to verify its effectiveness. METHODS: The hypothesis was verified by applying a randomized controlled pre- and post-test design through random assignment of two groups. Middle-aged (40-64 years) patients who underwent percutaneous coronary intervention for the first time were recruited from a university hospital in Seoul, Korea. For the experimental group, based on the Self-Determination Theory, risk factor- tailored counseling and education were provided individually for one hour based on the education booklet, and telephone counseling was conducted twice for 12 weeks. Differences in autonomous motivation, resilience, self-care compliance and biochemical indicators measured after 12 weeks in the experimental group and the control group were compared. Data were analyzed using SPSS/WIN ver. 22.0. RESULTS: The autonomous motivation, resilience, and self-care compliance of the experimental group were significantly higher than those of the control group (p < .05). Body mass index (p = .005) and current smoking rate (p < .001) were also significantly decreased in the experimental group but there was no significant difference in other biochemical parameters. CONCLUSION: For middle-aged patients with first coronary intervention, risk factor-tailored education emphasizing autonomy by nurses should be provided early after discharge. TRIAL REGISTRATION: This study was retrospectively registered in the Clinical Research Information Service and the identification number is KCT0008698(11/08/2023).
RESUMO
BACKGROUND: As patients with myocardial infarction (MI) survive for a long time after acute treatment, it is necessary to pay attention to the prevention of poor prognosis such as heart failure (HF). To identify the influencing factors of adverse clinical outcomes through a review of prospective cohort studies of post-MI patients, and to draw prognostic implications through in-depth interviews with post-MI patients who progressed to HF and clinical experts. METHODS: A mixed-method design was used that combined a scoping review of 21 prospective cohort studies, in-depth interviews with Korean post-MI patients with HF, and focus group interviews with cardiologists and nurses. RESULTS: A literature review showed that old age, diabetes, high Killip class, low left ventricular ejection fraction, recurrent MI, comorbidity of chronic disease and current smoking, and low socioeconomic status were identified as influencing factors of poor prognosis. Through interviews with post-MI patients, these influencing factors identified in the literature as well as a lack of disease awareness and lack of self-care were confirmed. Experts emphasized the importance of maintaining a healthy lifestyle after acute treatment with the recognition that it is a chronic disease that must go together for a lifetime. CONCLUSION: This study confirmed the factors influencing poor prognosis after MI and the educational needs of post-MI patients with transition to HF. Healthcare providers should continue to monitor the risk group, which is expected to have a poor prognosis, along with education emphasizing the importance of self-care such as medication and lifestyle modification.
