Why do only half of people who’ve survived a heart attack follow their doctor’s advice?

    1 September 2015

    The graphic below contains a surprising statistic. In a survey commissioned by AstraZeneca only half of people who had survived a heart attack said they had taken ‘proactive steps’ to avoid another one.

    It seems counter-intuitive that people who have endured such a trauma would choose not to take the steps (exercising, having a healthy diet, not smoking) most likely to ensure they live longer.

    Dr Joe Mills, a consultant cardiologist at Spire Cheshire hospital, says this is because too often heart attacks are seen as a one-off:

    ‘Patients do not know that a heart attack is an acute manifestation of a chronic disease process … They do not appreciate the long-term risks they face.’

    The medical processes that kick in once you’ve had a heart attack actually serve to deepen this misunderstanding rather than correct it, says Dr Mills. You are given medicines, possibly a stent, and are likely to see ‘before and after’ shots of an artery that has been cleared. You will also be in and out of hospital very quickly. ‘We don’t do very much to persuade patients that they haven’t been cured,’ says Dr Mills.

    Another factor is that cardiologists, proud of their work in clearing a blocked artery, may end up ‘over-egging’ its long-term benefits, Dr Mills says.

    ‘What you’ve done it’s actually a short-term repair job. The things that are going to make a difference to patients’ long-term outlook are these lifestyle interventions.’

    Dr Ameet Bakhai, cardiologist at Spire Bushey hospital, Watford and research deputy director at Royal Free, says an extra factor is that cardiologists are not supported in spending time with patients, talking them through the risks and benefits of lifestyle change.

    ‘The demands on the NHS pressure us in turn to spend less and less time with patients … We spend more time typing a procedural report than with a patient, because the report is essential to our trust getting reimbursed. But that’s not the best use of clinical expertise.

    ‘So much of our time is now spent on administrative tasks related to targets than compared to 10 years ago, even though we’re the best people to empower patients to … change their behaviour.’