Psychological factors

Most patients are clinically anxious on admission to hospital. This anxiety generally remits over the next couple of days but rises again just before discharge, when many patients may again become clinically anxious. This distress is often deliberately hidden from the staff and other patients. Once home, a reduction in mood—“home coming depression”—is almost universal and patients and partners should be warned that it is likely to happen, otherwise they may worry that their “mind” has been damaged as well as their heart. Patients should be assured that this reaction is not unique to surviving an MI but is common in survivors of any natural disaster. In the majority of patients, unless there are further acute events, anxiety and depression slowly remit over the following weeks. However, about a quarter of patients may remain distressed at one year. It takes only minutes to screen patients using the Hospital Anxiety and Depression Scale, and as many patients come back for an exercise test at 6–12 weeks postdischarge, this may be a good time to identify those likely to have long term adjustment problems and to refer them for appropriate counselling/treatment.

In the first few months of recovery many patients report a fear of resuming sex and, unless this is dealt with, some will never resume it. Partners share the same worries and their fear is often the major factor in reduced sexual activity and enjoyment. There is no evidence that sex is in anyway dangerous, and patients …