Thiruvananthapuram

Life after a heart attack

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Structured cardiac rehabilitation the need of the hour

Jayshanker was 39 and had just returned from UAE, when in 1999 he first experienced myocardial infarction (MI) or heart attack.

Though he says his lifestyle changed drastically afterwards, obviously he was not doing enough for he suffered a second MI two years later.

This time, however, he knew how lucky he was to have been given a second chance. He totally gave up smoking and got into a strict diet and physical activity regimen.

“I felt fine but my wife would not let me drive or travel alone anywhere. I had to deal with constant phone calls on what I had eaten, where I had been or why I was not home early...but I was determined to capture my life back,” says Jayshanker.

In 2014, it was by chance that he was detected to have developed Aortic Root Aneurysm, a condition which required him to undergo an immediate open heart surgery at Narayana Hrudyalaya. Five years later, Jayshanker continues to embrace life with gusto.

He still goes on long drives to Coimbatore and Goa as part of his business and remains as busy as ever. Jayshanker may be made of sterner stuff but for most people, a heart attack can be a traumatic and life-changing experience.

Despite adequate care, they often sink into anxiety about imminent death and believe themselves to be incapacitated for life. The lifestyle modifications and mobility restrictions placed on them lead to further decline in physical and mental health.

Quality of life

Cardiac care has advanced by leaps and bounds in the past several decades and improvements in ICU care, newer and potent drugs, and revascularisation procedures have significantly brought down mortality following MI to less than 5% today.

However, the focus of treatment has more or less been on preventing death, recurrent MI episodes or stroke, and less on ensuring the long term health and quality of life of MI survivors.

An editorial in the November 7 issue of Heart, brought out by British Medical Journal, has focused on the impact of cardiovascular diseases on patients and the fact that interventions specifically targeted at improving the quality of life patients, such as cardiac rehabilitation, remain underused.

One of the latest retrospective analysis of 9,566 patients treated for MI at 77 hospitals in England reported that at the end of one year, nearly 60% of the patients reported one or more perceived health problems in mobility, self care, pain/discomfort, and anxiety/depression.

“We discharge most of them in 72 hours and send them home with general advice and high dose of medications. On review, we find that life has changed for them dramatically. They seem to lose their self confidence and most are very anxious about their sex life and a possible recurrence of MI. There is much more to MI care than improving survival, and the quality of life of survivors has been sadly overlooked by us,” says Tiny Nair, a senior consultant in Cardiology.

“Depression is very common. The sudden changes imposed on them and the feeling of vulnerability leaves them very unsure of life. We need to counsel them and help them regain confidence but in Indian settings, the clinics are so busy that the job is delegated to nurses.

Better interaction with doctors can certainly improve the quality of life of patients,” says S. Harikrishnan, Professor of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology.

Twin goals

Unlike in the West, there are few organised cardiac rehabilitation programmes in hospitals where the patients can be counselled and walked through various aspects of daily living, including the kind of physical activity they should be doing.

Structured cardiac rehabilitation programmes are the need of the hour so that the twin goals of MI treatment – better clinical outcomes as well as excellent quality of life for MI survivors – can be achieved.

C. Maya

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Printable version | Jan 29, 2020 2:48:44 PM | https://www.thehindu.com/news/cities/Thiruvananthapuram/life-after-a-heart-attack/article30392127.ece

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