'I am still a bit unsure how much of a heart attack it really was!' Patients presenting with non ST elevation myocardial infarction lack understanding about their illness and have less motivation for secondary prevention

Background: There are considerable differences in the type of treatments offered to patients presenting with acute myocardial infarction (AMI), in terms of the speed and urgency with which they are admitted, treated and discharged from hospital. The impact of these different treatment experiences on patients' illness perception and motivation for behavioural changes is unknown. Aim: The aim of this study was to explore and compare patients' illness perception and motivation for behavioural change following myocardial infarction (MI) treated by different methods. Methods: Semi-structured, domiciliary interviews (n=15) based on the common sense model of self regulation, were conducted with three groups of MI patients within four weeks of diagnosis: (a) primary percutaneous coronary intervention (PPCI) (n=5); (b) thrombolysis (n=5); (c) non ST elevation MI (NSTEMI) (n=5). Framework analysis was used to identify and compare themes between groups. Results: Patients presenting with a ST-elevation MI (STEMI) receiving either PPCI or thrombolysis had similar perceptions of their illness as a serious, life-threatening event and were determined to make lifestyle changes. In contrast, patients with a NSTEMI experienced uncertainty about symptoms and diagnosis, causing misconceptions about the severity of their condition and less determination for lifestyle changes. Conclusion: Patients with NSTEMI in this study expressed very different perceptions of their illness compared to those experiencing STEMI. Patients' clinical presentation and treatment experience during an AMI can impact on their illness perception, motivation for behavioural change and uptake of cardiac rehabilitation. Nurses should consider the patients' illness experience and perception when planning secondary prevention interventions.