Fatigue common after heart attack

Half of all patients who undergo myocardial infarction (heart attack) are experiencing onerous fatigue four months after the infarction. The patients who are most fatigued are those who perceive the infarction as a sign of chronic illness, those who experience the illness as difficult to control, and those who believe that the illness has a large impact on their life. These are the conclusions of a thesis presented at the Sahlgrenska Academy, University of Gothenburg, Sweden.

Just over 200 persons completed a questionnaire one week after they had experienced an infarction and again four months later. Many of the patients were also interviewed.

Around half of the patients stated that they felt onerous fatigue four months after the infarction. One third of the patients exhibited expressed fatigue, while one fifth also exhibited symptoms of depression. "Many people experienced the fatigue as new, and different. It was not related to physical effort or a lack of rest; it occurred unpredictably and could not be attributed to any definite cause", says nurse Pia Alsén, author of the thesis.

Improvements in treatment during the acute phase of a myocardial infarction have lead to significantly more patients surviving, and to shorter periods of hospitalisation. However, medical treatment is not sufficient on its own to ensure a good long-term prognosis. Patients must also change their lifestyle, and many of them do not manage to carry out the changes that are needed. Further, some patients do not participate in the rehabilitation programmes that are available. "The patients' perception of their illness can be crucial in determining whether they benefit from this part of the treatment or not. A better understanding of the patients' perceptions of their illness can enable us to adapt the information individually for each patient, and encourage more patients to enter the follow-up programmes", says Pia Alsén.

More patients perceived their illness to be chronic four months after the infarction. "The perception that the condition was a chronic one depended on the extent to which the patients reflected over what had happened. Those who were unwilling to examine causes and correlations perceived the infarction as an isolated event", says Pia Alsén. A further factor that influenced the patients' perceptions of their illness was whether they felt that they could influence the illness themselves, or whether they placed their trust in medication and other external factors. The patients' belief that they could take control of their situation through such measures as changes in lifestyle decreased after four months.