When the hearts are sick: An evaluation of comprehensive secondary prevention program for heart patients, where changes in physical and mental health, lifestyles, and the patients' satisfaction with the health service given are in focus

Research questions: 1) Does physical and mental health improve in the first 6 weeks of the rehabilitation period? 2) Will the patients get a healthier lifestyle in the early rehabilitation phase? 3) Are the patients satisfied with the health service given at the Heart Outpatient Clinic? Design: Goal based evaluation research. Exploratory, quantitative pre-post-post study with semi structured self-reported questionnaires. Sample: The population was patients enrolled in a clinic's comprehensive prevention program for heart patients. The sample was a nonprobability single selected intervention group of 48 selected heart patients (31 men and 17 women) with cardiac infarction, angina pectoris and heart failure. Age ranged from 39 to 75. Mean age was 61,9. Stand. Dev. 9,31. The inclusion was consecutive. Results: 1) The results showed a significant improvement in both physical and mental health the first six weeks of the rehabilitation period. The improvement in physical health occurred mainly in the last three weeks, while the improvement in mental health occurred mainly in the first three weeks. 2) Significant changes in lifestyle were made in the following areas; physical activity and diastolic blood pressure increased, daily consume of cigarettes decreased, and the patients experienced a decreased amount of personal stress. The results showed no significant changes in body weight, alcohol consumption or systolic blood pressure. 3) The patients were in general very satisfied with the rehabilitation service given, but the findings suggest that there is room for improvement in the following areas; education (information, counselling and teaching), caring, communication and cooperation, motivation, use of written goals and plans for lifestyle changes, information on patients' rights, telephone support, discharge planning, continuity in doctor follow-up and contact with dietician, psychologist and physiotherapist. 4) Possible causes cannot be determined due to lack of control group. Some factors, such as gender, age, level of education, diagnosis, contact frequency with own children and friends, and health related opinions, seem to have had influence on the changes which took place. Implications for the rehabilitation team: Develop a standardized system to secure optimal rehabilitation. Include next of kin better in discharge planning, and the rehabilitation process. Show video films with a nurse present. Strengthen the patients' motivation for changes in lifestyle. Offer telephone follow up after discharge. Compose written goals and plans for life styles changes in cooperation with the patients. Give the patients a workbook including all relevant information. Improve communication, cooperation, and care. Improve patient education, and continuity in doctor follow-up. Offer contact with other health professionals.