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Using Animation to Improve Recovery from Acute Coronary Syndrome: A Randomized Trial

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Recovery from myocardial infarction has been associated with patients’ perceptions of damage to their heart. New technologies offer a way to show patients animations that may foster more accurate perceptions and encourage medication adherence, increased exercise and faster return to activities.

Purpose

The purpose of this study was to investigate the effects of a brief animated intervention delivered at the patients’ bedside on perceptions and recovery in acute coronary syndrome patients.

Methods

Seventy acute coronary syndrome patients were randomly assigned to the intervention or standard care alone. Illness perceptions, medication beliefs and recovery outcomes were measured.

Results

Post-intervention, the intervention group had significantly increased treatment control perceptions and decreased medication harm beliefs and concerns. Seven weeks later, intervention participants had significantly increased treatment control and timeline beliefs, decreased symptoms, lower cardiac avoidance, greater exercise and faster return to normal activities compared to control patients.

Conclusions

A brief animated intervention may be clinically effective for acute coronary syndrome patients (Trial-ID: ACTRN12614000440628).

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References

  1. Steg PG, Goldberg RJ, Gore JM, et al. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol. 2002; 90: 358-363.

    Article  PubMed  Google Scholar 

  2. Cooper AF, Jackson G, Weinman J, Horne R. Factors associated with cardiac rehabilitation attendance: A systematic review of the literature. Clin Rehabil. 2002; 16: 541-552.

    Article  CAS  PubMed  Google Scholar 

  3. Worcester MUC, Murphy BM, Mee VK, Roberts SB, Goble AJ. Cardiac rehabilitation programmes: Predictors of non-attendance and drop-out. Eur J Cardiov Prev R. 2004; 11: 328-335.

    Article  Google Scholar 

  4. Ewart CK, Taylor CB, Reese LB, DeBusk RF. Effects of early postmyocardial infarction exercise testing on self-perception and subsequent physical activity. Am J Cardiol. 1983; 51: 1076-1080.

    Article  CAS  PubMed  Google Scholar 

  5. Frasure-Smith N, Lespérance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatr. 2008; 65: 62-71.

    Article  CAS  PubMed  Google Scholar 

  6. Rudisch B, Nemeroff CB. Epidemiology of comorbid coronary artery disease and depression. Biol Psychiatr. 2003; 54: 227-240.

    Article  Google Scholar 

  7. Lespérance F, Frasure-Smith N, Talajic M. Major depression before and after myocardial infarction: Its nature and consequences. Psychosom Med. 1996; 58: 99-110.

    Article  PubMed  Google Scholar 

  8. Thombs BD, Bass EB, Ford DE, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006; 21: 30-38.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Riegel BJ. Contributors to cardiac invalidism after acute myocardial infarction. Coronary Artery Dis. 1993; 4: 215-220.

    Article  CAS  Google Scholar 

  10. Thompson DR, Lewin RJP. Management of the post-myocardial infarction patient: Rehabilitation and cardiac neurosis. Heart. 2000; 84: 101-105.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Mittag O, Kolenda KD, Nordmann KJ, Bernien J, Maurischat C. Return to work after myocardial infarction/coronary artery bypass grafting: Patients’ and physicians’ initial viewpoints and outcome 12 months later. Soc Sci Med. 2001; 52: 1441-1450.

    Article  CAS  PubMed  Google Scholar 

  12. Petrie KJ, Weinman J, Sharpe N, Buckley J. Role of patients’ view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study. Brit Med J. 1996; 312: 1191-1194.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Soejima Y, Steptoe A, Nozoe S, Tei C. Psychosocial and clinical factors predicting resumption of work following acute myocardial infarction in Japanese men. Int J Cardiol. 1999; 72: 39-47.

    Article  CAS  PubMed  Google Scholar 

  14. Eagle KA, Kline-Rogers E, Goodman SG, et al. Adherence to evidence-based therapies after discharge for acute coronary syndromes: An ongoing prospective, observational study. Am J Med. 2004; 117: 73-81.

    Article  PubMed  Google Scholar 

  15. Horwitz RI, Viscoli CM, Donaldson RM, et al. Treatment adherence and risk of death after a myocardial infarction. Lancet. 1990; 336: 542-545.

    Article  CAS  PubMed  Google Scholar 

  16. Irvine J, Baker B, Smith J, et al. Poor adherence to placebo or amiodarone therapy predicts mortality: Results from the CAMIAT study. Psychosom Med. 1999; 61: 566-575.

    Article  CAS  PubMed  Google Scholar 

  17. Redfern J, Hyun K, Chew DP, et al. Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: Results from a large prospective audit in Australia and New Zealand. Heart. 2014; 100: 1281-1288.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Leventhal H, Meyer D, Nerenz D. The common sense representation of illness danger. In: Rachman S, ed. Contributions to medical psychology. New York: Pergamon Press; 1980: 7-30.

    Google Scholar 

  19. Cherrington CC, Moser DK, Lennie TA, Kennedy CW. Illness representation after acute myocardial infarction: Impact on in-hospital recovery. Am J Crit Care. 2004; 13: 136-145.

    PubMed  Google Scholar 

  20. Juergens MC, Seekatz B, Moosdorf RG, Petrie KJ, Rief W. Illness beliefs before cardiac surgery predict disability, quality of life, and depression 3 months later. J Psychosom Res. 2010; 68: 553-560.

    Article  PubMed  Google Scholar 

  21. Dickens C, McGowan L, Percival C, et al. Negative illness perceptions are associated with new-onset depression following myocardial infarction. Gen Hosp Psychiatr. 2008; 30: 414-420.

    Article  Google Scholar 

  22. Ades PA, Huang D, Weaver SO. Cardiac rehabilitation participation predicts lower rehospitalization costs. Am Heart J. 1992; 123: 916-921.

    Article  CAS  PubMed  Google Scholar 

  23. French DP, Cooper A, Weinman J. Illness perceptions predict attendance at cardiac rehabilitation following acute myocardial infarction: A systematic review with meta-analysis. J Psychosom Res. 2006; 61: 757-767.

    Article  PubMed  Google Scholar 

  24. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999; 47: 555-567.

    Article  CAS  PubMed  Google Scholar 

  25. Broadbent E, Ellis CJ, Thomas J, Gamble G, Petrie KJ. Can an illness perception intervention reduce illness anxiety in spouses of myocardial infarction patients? A randomized controlled trial. J Psychosom Res. 2009; 67: 11-15.

    Article  PubMed  Google Scholar 

  26. Broadbent E, Ellis CJ, Thomas J, Gamble G, Petrie KJ. Further development of an illness perception intervention for myocardial infarction patients: A randomized controlled trial. J Psychosom Res. 2009; 67: 17-23.

    Article  PubMed  Google Scholar 

  27. Petrie KJ, Cameron LD, Ellis CJ, Buick D, Weinman J. Changing illness perceptions after myocardial infarction: An early intervention randomized controlled trial. Psychosom Med. 2002; 64: 580-586.

    Article  PubMed  Google Scholar 

  28. Williams B, Anderson AS, Barton K, McGhee J. Can theory be embedded in visual interventions to promote self-management? A proposed model and worked example. Int J Nurs Stud. 2012; 49: 1598-1609.

    Article  CAS  PubMed  Google Scholar 

  29. Devcich DA, Ellis CJ, Broadbent E, Gamble G, Petrie KJ. The psychological impact of test results following diagnostic coronary CT angiography. Health Psychol. 2012; 31: 738-744.

    Article  PubMed  Google Scholar 

  30. Devcich DA, Ellis CJ, Gamble G, Petrie KJ. Psychological responses to cardiac diagnosis: Changes in illness representations immediately following coronary angiography. J Psychosom Res. 2008; 65: 553-556.

    Article  PubMed  Google Scholar 

  31. Karamanidou C, Weinman J, Horne R. Improving haemodialysis patients’ understanding of phosphate-binding medication: A pilot study of a psycho-educational intervention designed to change patients’ perceptions of the problem and treatment. Brit J Health Psych. 2008; 13: 205-214.

    Article  Google Scholar 

  32. Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: A randomized clinical trial. Aids Patient Care ST. 2014; 28: 579-586.

    Article  Google Scholar 

  33. Faul F, Erdfelder E, Lang A, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39: 175-191.

    Article  PubMed  Google Scholar 

  34. Nash MP, Hunter PJ. Computational mechanics of the heart. J Elasticity. 2000; 61: 113-141.

    Article  Google Scholar 

  35. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006; 60: 631-637.

    Article  PubMed  Google Scholar 

  36. Broadbent E, Wilkes C, Koschwanez HE, Weinman J, Norton S, Petrie KJ. A systematic review and meta-analysis of the brief illness perception questionnaire. Psychol Health. 2015. doi:10.1080/08870446.2015.1070851.

    Google Scholar 

  37. Petrie KJ, Broadbent E, Kydd R. Illness perceptions in mental health: Issues and potential applications. J Ment Health. 2008; 17: 559-564.

    Article  Google Scholar 

  38. Broadbent E, Petrie KJ, Ellis CJ, Ying J, Gamble G. A picture of health—myocardial infarction patients’ drawings of their hearts and subsequent disability: A longitudinal study. J Psychosom Res. 2004; 57: 583-587.

    Article  PubMed  Google Scholar 

  39. Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999; 14: 1-24.

    Article  Google Scholar 

  40. Eifert GH, Thompson RN, Zvolensky MJ, et al. The cardiac anxiety questionnaire: Development and preliminary validity. Behav Res Ther. 2000; 38: 1039-1053.

    Article  CAS  PubMed  Google Scholar 

  41. Horne R, Weinman J. Self-regulation and self-management in asthma: Exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002; 17: 17-32.

    Article  Google Scholar 

  42. Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Resp Crit Care. 1994; 149: 69-76.

    Article  Google Scholar 

  43. Kravitz RL, Hays RD, Sherbourne C, et al. Recall of recommendations and adherence to advice among patients with chronic medical conditions. Arch Intern Med. 1993; 153: 1869-1878.

    Article  CAS  PubMed  Google Scholar 

  44. Broadbent E, Ellis CJ, Gamble G, Petrie KJ. Changes in patient drawings of the heart identify slow recovery after myocardial infarction. Psychosom Med. 2006; 68: 910-913.

    Article  PubMed  Google Scholar 

  45. Vickers AJ, Altman DG. Statistics notes: Analysing controlled trials with baseline and follow up measurements. Brit Med J. 2001; 323: 1123-1124.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Perneger TV. What’s wrong with Bonferroni adjustments. Brit Med J. 1998; 316: 1236-1238.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Benner JS, Pollack MF, Smith TW, Bullano MF, Willey VJ, Williams SA. Association between short-term effectiveness of statins and long-term adherence to lipid-lowering therapy. Am J Health-Syst Ph. 2005; 62: 1468-1475.

    Article  CAS  Google Scholar 

  48. Kaptein AA, Zandstra T, Scharloo M, et al. ‘A time bomb ticking in my head’: Drawings of inner ears by patients with vestibular schwannoma. Clin Otolaryngol. 2011; 36: 183-184.

    Article  CAS  PubMed  Google Scholar 

  49. Ramondt S, Tiemensma J, Cameron LD, Broadbent E, Kaptein AA. Patients’ drawings of blood cells reveal patients’ perception of sickle cell disease. Psychol Health. 2013; 28: 139-140.

    Article  Google Scholar 

  50. Reynolds L, Broadbent E, Ellis CJ, Gamble G, Petrie KJ. Patients’ drawings illustrate psychological and functional status in heart failure. J Psychosom Res. 2007; 63: 525-532.

    Article  PubMed  Google Scholar 

  51. Tiemensma J, Daskalakis NP, van der Veen EM, et al. Drawings reflect a new dimension of the psychological impact of long-term remission of Cushing’s syndrome. J Clin Endocr Metab. 2012; 97: 3123-3131.

    Article  CAS  PubMed  Google Scholar 

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Compliance with Ethical Standards

ᅟ

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Jones, Ellis, Nash, Stanfield and Broadbent declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individuals included in the study.

Author information

Authors and Affiliations

  1. Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand

    Annie Selina Kozlowski Jones MHealthPsyc & Elizabeth Broadbent PhD

  2. Department of Cardiology, Auckland District Health Board, Private Bag 92019, Auckland, New Zealand

    Christopher J. Ellis MBChB & Brad Stanfield

  3. Auckland Bioengineering Institute and Department of Engineering Science, The University of Auckland, Private Bag 92019, Auckland, New Zealand

    Martyn Nash PhD

Authors
  1. Annie Selina Kozlowski Jones MHealthPsyc
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  2. Christopher J. Ellis MBChB
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  3. Martyn Nash PhD
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  4. Brad Stanfield
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  5. Elizabeth Broadbent PhD
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Corresponding author

Correspondence to Elizabeth Broadbent PhD.

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Jones, A.S.K., Ellis, C.J., Nash, M. et al. Using Animation to Improve Recovery from Acute Coronary Syndrome: A Randomized Trial. ann. behav. med. 50, 108–118 (2016). https://doi.org/10.1007/s12160-015-9736-x

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  • DOI: https://doi.org/10.1007/s12160-015-9736-x

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