title: UPBEAT study patients' perceptions of the effect of coronary heart disease on their lives: a cross-sectional sub-study.
abstract: BACKGROUND
  Patients can report positive effects of myocardial infarction. It is unknown whether these effects are sustained or what factors influence adaptation.
  
  
  OBJECTIVE
  To explore primary care patients' perceptions of the effect of coronary heart disease and to identify possible modifiable predictors of adaptation.
  
  
  METHODS
  Cross-sectional, sub-study of UPBEAT cohort participants. Patients were recruited from coronary heart disease Registers in South London General Practices.
  
  
  METHODS
  548 participants were asked "Has having heart disease changed your life? If so, was that change for the better, worse, both or neither?" Participants were asked to explain their response; explanations were subjected to content analysis. Associations between response and lifestyle, demographic, mood and coronary heart disease variables were tested.
  
  
  RESULTS
  Respondents (394 male, 72%) were aged 27-98 years and had had heart disease for a mean of 12.4 SD ± 8.4 years. 120 (22%) reported that life was better and 200 (37%) said it was worse. The explanations of those who said 'better' were categorised as 'Healthier Living', 'Recognised Mortality' and 'Stress Reduction'. For those saying 'worse', categories were 'Restricted Lifestyle', 'Recognised Mortality', 'Loss and Burden'. More anxiety symptoms (RRR 1.56, 95% CI 1.12, 2.17), lower functional status (RRR 2.46, 95% CI 1.21, 4.98) and self-reported chest pain (RRR 2.24, 95% CI 1.34, 3.77) were associated with saying 'worse'.
  
  
  CONCLUSIONS
  Many primary care patients are ambivalent to the effects of coronary heart disease, but some report positive effects. Negative perceptions are associated with reported functional impairment, chest pain and anxiety, but not illness severity or patient characteristics. Future work will track the implications of these perceptions, but nurses managing patients with coronary heart disease should consider these effects as they may be modifiable predictors of adaptation.
authors.affiliation: Primary Care Mental Health, Health Services and Population Research Dept, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Smith
authors.affiliation: Primary Care Mental Health, Health Services and Population Research Dept, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Fortune
authors.affiliation: Primary Care Mental Health, Health Services and Population Research Dept, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Phillips
authors.affiliation: Primary Care Mental Health, Health Services and Population Research Dept, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Walters
authors.affiliation: The Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
authors.forename: Geraldine A
authors.initials: GA
authors.lastname: Lee
authors.affiliation: Primary Care Mental Health, Health Services and Population Research Dept, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mann
authors.affiliation: Primary Care Mental Health, Health Services and Population Research Dept, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK.
authors.forename: André
authors.initials: A
authors.lastname: Tylee
authors.affiliation: The Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. Electronic address: elizabeth.barley@kcl.ac.uk.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Barley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Affect; Attitudes; Coronary heart disease; General practice; Perception; Primary health care