Conceptual Framework for Personal Recovery in Patients With Acute Myocardial Infarction

Abstract

Background Although there has been movement in cardiology to advance patient‐centered approaches to postacute myocardial infarction (AMI) care, work remains to be done in aligning patient preferences with clinical care. Our objective was to characterize patients’ experience of AMI and treatment to develop a new conceptual framework of patient‐centered recovery in cardiology. Methods and Results We conducted in‐depth interviews with people who previously experienced an AMI (2016–2019). The interview focused on participants’ experiences of their recovery, which were audio‐recorded, transcribed verbatim, and analyzed using a phenomenological framework. The overarching theme described by the 42 participants was feeling like a “different person” after the AMI. This shift manifested itself in both losses and gains, each of which posed new challenges to everyday life. The experience appeared to be an active process requiring people to take responsibility for their health. In terms of loss, participants describe how the AMI threatened their sense of safety and security and led to social isolation, fragility, uncertainty about the future, and difficulty expressing emotions accompanied this new fear. A conceptual framework describing the relationship between AMI, identity change, and functioning was developed. Conclusions Participants experienced the AMI as an unexpected disruption in their lives that had far‐reaching effects on their daily functioning, and were resolved in numerous ways. The conceptual framework may assist in providing a theoretical basis for future interventions in cardiology that not only engage and retain patients in care but also improve long‐term adherence to secondary prevention and other aspects of self‐care.

The association of marital/partner status with patient-reported health outcomes following acute myocardial infarction or stroke: Protocol for a systematic review and meta-analysis

“…An outcome framework ( Fig 2 ) based on American Heart Association statement papers and prior research [ 9 , 11 , 26 ] was designed to classify PROM outcomes. We started from the patient-reported outcome taxonomy of Rumsfeld et al and Reeves et al for AMI and stroke, respectively, in which PROMs were classified into three domains (HRQoL, functional status, and symptoms) [ 9 , 11 ].…”

“…We started from the patient-reported outcome taxonomy of Rumsfeld et al and Reeves et al for AMI and stroke, respectively, in which PROMs were classified into three domains (HRQoL, functional status, and symptoms) [ 9 , 11 ]. To capture outcomes from a bio-psycho-social perspective, we further added a “personal recovery” outcome domain based on a conceptual framework of patient-centered recovery in cardiology proposed by Dreyer et al, [ 26 ] which is also supported by stroke literature [ 27 ]. Personal recovery refers to a multidimensional process—“a deeply personal, unique process of changing one’s attitudes, values, feeling, goals, skills and/or roles.” Examples of personal recovery outcomes are competence, empowerment, well-being, and activation.…”

“…An outcome framework (Fig 2) based on American Heart Association statement papers and prior research [9,11,26] was designed to classify PROM outcomes. We started from the…”

Association of Sociodemographic Characteristics With 1-Year Hospital Readmission Among Adults Aged 18 to 55 Years With Acute Myocardial Infarction

“…34 Our study broadens the existing evidence by taking into consideration a wide spectrum of SDOHs under the World Health Organization conceptual framework 32 process as a deeply personal, unique process associated with daily functioning, which may result in changes in SDOHs, such as employment status, psychological stress, and perceived social support. 33 Our findings necessitate further research to explore other unmeasured factors that explain the racial differences in readmission at 1 year, including structural racism 35 and implicit bias, 35,36 as well as more focus on addressing these upstream influences.…”

“… 28 , 29 However, traditional cardiac risk factors and comorbidities alone cannot fully explain the racial differences in AMI readmission in younger individuals. The association of race, as a social construct, 30 directly with these factors 31 , 32 and indirectly through SDOHs 10 , 32 , 33 should also be considered. Our study shows higher odds of readmission at 1 year for participants with low socioeconomic status, low social support, and high stress.…”