P492 NARRATIVE OF PATIENTS WITH ACUTE CORONARY SYNDROME: FROM THE EVENT TO THE END OF A CARDIAC REHABILITATION PROGRAM

Abstract

Abstract Background Acute Myocardial infarction (AMI) is often a sudden event that requires urgent and invasive therapeutic measures. After AMI, patients enter the world of chronic diseases with strong personal repercussions. Purpose of the Study To investigate experience of patients with AMI and how it evolves at different stages of the treatment pathway in order to help health professionals to improve and to individualise different aspects of treatment. Material and Methods A semi–structured diary outline and Plutchik‘s wheel of emotions (on which the patient had to underline his three predominant emotions) was proposed to 30 patients affected by AMI: 10 within 48 hours of the event, 10 immediately before and 10 immediately after a cardiac rehabilitation program (CRP). Narrative about the experience related to the IMA moment was collected in each phases, while aspects concerning current situation and CRP were added to the traces proposed before and after cardiac rehabilitation. The texts produced by patients were analysed using specific methods of Narrative Medicine (Kleiman‘s, Lowner/Robinson‘s and Frank‘s classification). Plutchik‘s wheel results were processed as word–cloud. Results Negative emotions dominate in narratives collected during acute phase (FIG 1) where themes such as hopelessness, uncertainty, loss of control, guilt are recurrent. Sometimes tendency towards progression is identifiable, but always inside a narrative structure that conveys a precariousness experience. In the phase preceding CRP, most violent negative emotions disappear and positive emotions surface (FIG 2). The desire to understand situation becomes a main narrative theme and trust in health professionals appears as a coping element. Also in still narratives, elements of progression are evident, sometimes predominant. A prevalent restitution component emerges with strong expectations in CRP results. At the end of CRP, a further positive change in emotions is evident (FIG 3). All narratives become in progression and quest elements sometimes appear. Conclusions Narratives show an evolution of AMI patients experience from acute event to the end of CRP. Our study allowed to obtain useful elements to improve the approach to the AMI patient during the acute phase, to ameliorate anamnestic collection in the post–acute phase and to individualise rehabilitation pathway making it more customized and effective.