Illness perception interventions for heart attack patients and their spouses: Invited commentary

Abstract

While there is evidence of a recent decline in the incidence of heart attack in several Western countries, heart disease is still the leading cause of death [1]. In the UK, for example, about 146,000 people had heart attacks in 2006 and the estimated health care costs of coronary heart disease were over £3 billion [2]. A substantial proportion of patients who have a heart attack are of working age [3]. Return to work after a heart attack is associated with better subsequent quality of life [4], but many patients fail to return to work [5]. The first of the two linked papers by Broadbent et al. [14] which appear in this issue describes a randomized controlled trial, carried out in Auckland, New Zealand, of an intervention to increase rates of return to work after heart attack. The experience of a heart attack can be more distressing for patients' relatives than for the patients themselves [6]. A growing literature suggests that relatives, particularly spouses, of heart attack patients experience high levels of anxiety and worry, which impact negatively on their quality of life [7]. A recent systematic review suggested that there is dearth of research on interventions to alleviate the distress of relatives of heart patients in general [8]. The second paper discussed here describes an additional component of the intervention targeted at reducing anxiety in spouses of heart attack patients. Both of these interventions were informed by the Common-Sense Model (CSM) of illness representations