Self-management of angina symptoms appears to be poor among patients who have undergone elective percutaneous coronary intervention (PCI), with a number of factors contributing to this behaviour, a study has found, highlighting the need for careful evaluation of patients’ self-management skills to inform effective self-management strategies.

The results, which were presented at the Singapore Prevention & Cardiac Rehabilitation Symposium (SPCRS) 2017, showed that among the 93 patients with coronary heart disease (CHD; mean age 66.25 years; 75.3 percent male; 86 percent Caucasian) who had undergone elective PCI in the previous 3 months, majority (n=69; 74.2 percent) managed their angina symptoms inappropriately. [SPCRS 2017, abstract N30]

Approximately 17 percent (n=16) would summon an emergency ambulance for assistance during any recurrence of symptoms, however slight or short-lived. The patients who were more likely to know how to manage angina symptoms were younger or had more threatening perceptions of their CHD.

Factors such as older age, presence of comorbidities, low self-efficacy, lack of support from healthcare providers, less threatening perceptions of CHD and fear appeared to compromise the patients’ effective self-management of angina symptoms.

Qualitative analysis of interview data from 10 patients from the original sample suggested that older participants, especially those with comorbidities, were more stoical in such a way that they often trivialized their angina symptoms.

The three key factors that influenced how patients dealt with their angina symptoms were emotional representations (eg, fear, denial), the perceived seriousness of the symptoms and how peers manage their angina symptoms.

“Many participants claimed that they had never received any information about angina management from the healthcare providers, even though they had attended cardiac rehabilitation,” researchers said.

“Further research is [therefore] required to determine the most effective approach for healthcare providers to support patients’ angina management after elective PCI,” they continued. An economic analysis may be performed to examine the impact of patients’ poor angina self-management on the national health service, as well as determine the cost to the patients.

CHD is considered to be a true pandemic, killing about eight million people worldwide each year. To control angina symptoms, CHD patients can undergo PCI. However, recurring pain occurs commonly after the procedure, affecting between 33 and 75 percent of patients. [http://www.escardio.org/about/Documents/EU-cardiovascular-disease-statistics-2012.pdf; Eur J Cardiovasc Nurs 2008;7:73-79; Eur J Cardiovasc Nurs 2009;8:190-199]