Patients reporting to be healthy and not needing to change lifestyle after percutaneous coronary intervention - a cause for action?
Authors: Hjertvikrem N , Pettersen T R , Brors G , Helmark C , Instenes I , Ramstad K J , Norekval T M 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): The Western Norway Health Authority, The Norwegian Nurses Association

Background
A substantial proportion of patients with coronary artery disease do not achieve risk factors control, and are subsequently readmitted to hospital. In addition to decreased longevity, this increases the burden to the healthcare system and already strained resources.

Aim
To determine lifestyle and clinical characteristics of patients reporting to be healthy and not needing to change their lifestyle after percutaneous coronary intervention (PCI).

Methods
CONCARDPCI is a prospective multicentre cohort study including 3417 patients after PCI at seven Norwegian and Danish university hospitals during 2017-2019. Socio-demographic characteristics were obtained by self-report during the index hospitalization for PCI, and self-report on perceived health and the need to do lifestyle changes were repeated after 12 months. Clinical data were collected from patients’ medical records and the Norwegian Registry on Invasive Cardiology. Descriptive statistics, as well as t-test and chi-square test, scrutinized the aim.

Results
At baseline, 18% reported to be healthy and not needing to change their lifestyle. This increased to 28% (p&lt;0.001) at 12 months. Most patients were men (78%) with a mean age of 66 years (SD 11, range 20-96 years). A sizeable proportion had previous cardiovascular comorbidities, including history of myocardial infarction (21%), hypertension (52%) and hypercholesterolemia (47%). Further, 27 % were obese (BMI &gt;=30), 17% were smoking, 26% had previous PCI, and 9% previous coronary artery bypass grafting (CABG). Patients reporting to be healthy and not needing to change their lifestyle were older (69 vs 65, p&lt;0.001). At baseline, compared to the total study population, significantly fewer patients with history of: hypercholesterolemia 13% (p = 0.002), hypertension 12% (p = 0.001), previous PCI 11% (p&lt;0.001), previous CABG 9% (p&lt;0.001), obesity 6% (p&lt;0.001) and smoking 4% (p&lt;0.001) reported to be healthy and asserted not needing to change lifestyle. After 12 months, more patients with risk factors reported to be both healthy and not needing to change lifestyle: those having hypercholesterolemia 25% (p&lt;0.001), hypertension 25% (p&lt;0.001), obesity 17% (p&lt;0.001) and smoking 11% (p&lt;0.001), as well as those with history of previous PCI 19% (p&lt;0.001) or CABG 18% (p&lt;0.001). Although the proportion was less for those with history of risk factors than for the total study population at 12 months, the increase in this group was large and significant.

Conclusion
The proportion of patients reporting to be healthy and not needing to change their lifestyle increased significantly in the longer term. This applied especially to patients with risk factors such as hypercholesterolemia, hypertension, obesity and current smoking, as well as those with history of previous PCI or CABG. For patients to better understand the seriousness and implications of their disease, patient education and increased health literacy is important.