Perceptions of cause of illness in acute myocardial infarction patients: A longitudinal study

Objective: To assess change in patient's attributions of illness over the long term in patients with acute myocardial infarction (AMI). Methods: 178 patients were asked during the index hospitalization and 2-2.5 years after discharge whether they thought each of 13 possible factors may have contributed to their illness. Two dichotomous variables, conventional attribution (attribution to traditional risk factors, CA) and psychosocial attribution (PA), were defined and assessed for each patient. Results: General stress, cigarette smoking, and heredity were the most commonly mentioned attribution for the AMI. The proportion of individuals with positive CA increased at follow up. There was little congruence between patients' attributions and actual self-reported risk factors, either at baseline or at follow up. Age, education, country of birth, and anxiety were found as independent predictors of illness attribution. The participation in a cardiac prevention and rehabilitation program (CPRP) did not contribute to a significant change in CA attributions. Conclusion: Substantial proportions of patients have a poor understanding of the causes of their AMI both at onset of the illness and 2-2.5 years later, notwithstanding CPRP. Practice implications: The health care system can ill afford complacency with regards patient education and understanding.