Lifestyle Messages After PCI Need to Be Hit Harder



MUNICH – Despite undergoing a lifesaving coronary intervention, patients are failing to heed the message from physicians to adopt a heart-healthy lifestyle, according to a patient survey.

Among 1,703 Swedish patients surveyed within 8 weeks of an acute percutaneous coronary intervention (PCI), 16% were still smoking, 45% had inadequate dietary habits, and just 47% were physically active, Dr. Joep Perk reported at the annual congress of the European Society of Cardiology.

"When we asked them, ‘Why did you get your myocardial infarction?’ they said, ‘It’s in the family, it’s my age. It has nothing to do with smoking or running around eating," Dr. Perk said.

"They thought it was something you could not influence and had to go to the doctor to get mended, and the next time it breaks down, you have to go back to the doctor again."

Patients, however, may not get that chance.

Patients who reported persistent smoking and nonadherence to diet and exercise had a 3.8-fold higher risk of myocardial infarction (MI), stroke, or death within 6 months of PCI in the massive OASIS-5 (Organization to Assess Strategies in Acute Ischemic Syndromes 5) study, involving 18,809 patients from 41 countries, observed Dr. Perk, a senior professor at Linnaeus University in Kalmar, Sweden, and editor of the European Journal of Preventive Cardiology.

In contrast, quitting smoking dramatically reduced the risk of MI (odds ratio, 0.57), as did diet and exercise adherence (OR, 0.52), he said.

Using the 6% post-PCI rate for all cardiac events reported in OASIS-5, Dr. Perk and his colleagues conducted the SPICI (Study of Patient Information after Coronary Intervention) study, and estimated that the expected cardiac event rate in the Swedish population would be 1,100-1,200 events annually.

Thus, a prudent estimate indicates that at least 400-500 cases of MI, cardiac death, or stroke could be prevented if the Swedish post-PCI population would adhere 100% to a cardioprotective lifestyle, saving the lives of 150-200 persons yearly, he reported in the poster presentation.

Clearly, cardiac rehabilitation programs need to find news ways to reach their patients. Many of the patients in SPICI reported searching the Internet or asking friends and relatives for advice post PCI, while only 78% were invited to exercise training programs and 71% received nutritional counseling.

"There is fantastic room for improvement," Dr. Perk said in a press briefing. "We feel cardiac rehabilitation has lost touch with modern interventional cardiology."

Part of the problem is that some physicians may not be aware of the "really explosive information" in OASIS-5, or may focus their message on cure rather than grim statistics and the need to modify bad habits. Others may reach out to their patients too soon after PCI, when they are in a state of "shock" and unable to process information about lifestyle changes, Dr. Perk said in an interview.

"Timing is very important," he said. "Patients need time to think and consider what they can do themselves."

In this study, most patients expressed the belief that after PCI their disease was cured. Or they thought that if it were to come back, it would merely mean another trip to the PCI lab, an attitude that Dr. Perk considers "a fatal mistake."

Patients seemed to comprehend the need for lifestyle changes equally as poorly whether the message was delivered by physicians or nurses. Patient age and gender also had no significant impact on the uptake of healthy lifestyle choices, he said.

If physicians want to get their message across, he suggests they engage the patient’s partner and family, use modern educational technology such as interactive Internet-based models or support groups, and engage educators to help hone the communication skills of health professionals.

Dr. Michel Bertrand, past president of the European Society of Cardiology (ESC), said in an interview, "I am pessimistic because in spite of all that we tell our patients – ‘You need to stop smoking, you need to exercise, you need to have a good diet’ – they don’t do it."

He pointed to data from the cross-sectional EUROASPIRE I, II, and III studies showing that blood pressure, lipid targets, and smoking rates remained the same among patients with coronary heart disease despite a substantial increase in antihypertensive and lipid-lowering drugs (Lancet 2009;373:929-40).

In addition, investigators with the FAST-MI (French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction) study reported at the same ESC meeting that the proportion of female ST-segment elevation MI patients under age 60 more than doubled, from 11.8% to 25.5%, and the number under age 50 tripled, from 3.7% to 11.1% from 1995 to 2010 (JAMA Aug. 27 [doi: 10.1001/2012.jama.11348]).


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