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Patient confidence regarding secondary lifestyle modification and knowledge of ‘heart attack’ symptoms following percutaneous revascularisation in Japan: a cross-sectional study
  1. Hiroki Kitakata,
  2. Takashi Kohno,
  3. Shun Kohsaka,
  4. Junko Fujino,
  5. Naomi Nakano,
  6. Ryoma Fukuoka,
  7. Shinsuke Yuasa,
  8. Yuichiro Maekawa,
  9. Keiichi Fukuda
  1. Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
  1. Correspondence to Dr Takashi Kohno; kohno.a2{at}


Objective To assess patient perspectives on secondary lifestyle modification and knowledge of ‘heart attack’ after percutaneous coronary intervention (PCI) for coronary artery disease (CAD).

Design Observational cross-sectional study.

Setting A single university-based hospital centre in Japan.

Participants In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident).

Primary outcome measure The primary outcome assessed was the patients’ confidence level regarding lifestyle modification and the recognition of heart attack symptoms.

Results Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered ‘yes’ to the item ‘I should go to the hospital as soon as possible when I have a heart attack’; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions.

Conclusions There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care.

  • coronary artery disease
  • patient perspective
  • confidence
  • lifestyle
  • patient education

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  • Contributors HK and TK had full access to all data and were responsible for the integrity and accuracy of data analysis. HK, TK and SK were responsible for the study design and drafting of the manuscript. HK, TK, JF, NN and RF were involved in the acquisition and analysis of data. HK, TK, SK, SY and YM did the interpretation of data. SY, YM and KF critically revised the manuscript for intellectual content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Keio University School of Medicine Ethics Committee (approval no. 20110263).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The dataset analysed during this study are available from the corresponding author (TK, on reasonable request.

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