Patients' perceptions of their heart attack and recovery: the influence of epidemiological "evidence" and personal experience

Secondary prevention of heart disease is widely viewed as likely to be more successful and cost effective than primary prevention. However, people's willingness to adopt lifestyle change is a complex issue in which people's perceptions of disease causation and risk as well as a range of socio-economic factors are important. This paper reports on a qualitative study of people following heart attack which examines their understandings of heart attack and the salience that lifestyle advice has in the light of these understandings. In-depth, qualitative interviews were conducted with 25 people recovering from heart attack. Each person was interviewed twice: at around two weeks and five months following their heart attack. The study found that information about recovery provided by health professionals was based on a simplified version of epidemiological evidence. This information played a central role in people's understandings about the nature of heart attack and their future risk in the early weeks following heart attack. However, as interviewees came to terms with the shock of the event, they tended to lose their trust in "official" accounts of cause and recovery and evidence from lay epidemiology that contradicted official accounts tended to emerge. This evidence encouraged interviewees to question the explanatory power of official accounts and to view the adoption of long-term lifestyle change as an action that would not guarantee protection from a further heart attack. This was true whether or not people's experiences of recovery reflected those "predicted" by health professionals although those awaiting further surgery or tests tended to maintain trust in official accounts over a longer period. It is concluded that the failure of official accounts to acknowledge the random nature of the occurrence of heart attack, the severity of heart attack and the level of recovery from heart attack is a central feature in people's reluctance to view lifestyle change as a rational action to take to prevent a further cardiac event.