A cross-sectional study of the knowledge of post-myocardial infarction patients in a low-middle-income country regarding myocardial infarction and adherence to secondary preventive strategies practices
Authors: Dahanayake Dilhara Nayomini , Yoosoof Farah , Chathuranga Konara Mudiyanselage Nadeeshan Thar , Jayakody Chathuni Pamodya , Janadari Wickramage Dona Buddhi Chathurika , Pelden Kencho , Saranapala Ishara Udithamali , Ruwanpathirana Gayathma Kavindi , Shamith Moosa Lebbe Mohamed 
Published: July 2023

Objectives:
Myocardial infarction (MI) is a leading cause of death worldwide and is associated with a sizeable economic impact in terms of health expenditure and loss of workforce. Current trends depict Central and South Asia to be the epicenter of this public health issue which is only set to worsen with predicted population growth. Added to this, the history of a single MI increases the risk for subsequent episodes. Improved cardiovascular-related health literacy including knowledge of the illness and secondary preventive strategies is a major precautionary strategy in the prevention of subsequent MI in post-MI patients, which can, in turn, lead to major health and economic benefits. An understanding of the nature and level of health literacy can identify roadblocks to secondary preventive programs and help target interventions to suit the needs of the local healthcare setting and individuals. Thus, the objective of this study was to describe the current level of knowledge regarding MI and its secondary preventive strategies as well as the self-reported level of adherence to preventive strategies in a cross-section of post-MI patients in a healthcare center in Sri Lanka. It also explored the association of self-reported adherence with secondary preventive strategies and the level of knowledge.

Materials and Methods:
A cross-sectional descriptive study was conducted on consenting attendees to a cardiology clinic with a history of at least one MI in the past. A pre-tested and researcher-administered questionnaire collected sociodemographic data and tested the participant’s knowledge on various aspects of MI and secondary preventive strategies. Knowledge subscores in each category were summed to determine the overall knowledge level. The participants also self-reported their adherence to secondary preventive strategies. The knowledge level and level of adherence to preventive strategies were then categorized as either excellent, good, or poor. Descriptive statistics were calculated as frequencies and percentages. Fishers extract test was used to determine the relationship between overall knowledge level and level of adherence.

Results:
Among the sample of 120 post-MI clinic patients, the overall knowledge score showed that two-thirds of the sample possessed a good level of overall knowledge (61.7%), while 36.7% of participants had an excellent knowledge level, and only 1.7% had poor knowledge. The self-reported compliance with preventive practices of a majority (68.3%) of the participants was excellent, while just below one-third of the participants (30.0%) had a good level of compliance. Overall knowledge and self-reported compliance with secondary preventive strategies were not influenced by sociodemographic factors in this sample and no significant association could be determined between the level of adherence and knowledge.

Conclusion:
While local secondary preventive programs for post-MI patients seem to be showing some success, the relative deficiency of knowledge in lifestyle modifications as preventive strategies and the lack of association between assessed knowledge levels and adherence with secondary preventive strategies suggests that more attention should be paid to help patients translate and apply recommended secondary preventive strategies in their daily life.