Barriers to Patients' Heart Health Beyond Physician Control
(Enlarge Image)
Figure 3.
Patient vs physician initiation of discussions
Whereas nearly all physicians surveyed said that they initiate discussions on heart health with their patients, only about one half of them would initiate a discussion on sex after a heart attack.
Dr. Martha Gulati (The Ohio State University) was not surprised by these findings: "This is something most doctors are not well-trained in and are often uncomfortable asking. Nonetheless, this affects patients, [and it] can cause marital stress and major family issues if this isn't addressed," she said via email.
Indeed, data from the TRIUMPH registry show that sexual activity declines in the year after an MI for patients who do not receive specific advice on this topic from their doctors. Most of the patients in this study did not receive discharge instructions about resuming sexual activity; only one half of the 1274 men (47%) and one third of the 605 women did.
The AHA statement on sexual activity and CVD notes that sexual activity is reasonable 1 or more weeks after uncomplicated MI for patients free of symptoms during mild to moderate physical activity. But as Dr. Gulati noted, "How good are the [guidelines] if they aren't used and applied to patients?"
Because patients may be uncomfortable bringing up the subject, she suggested addressing it as a routine part of screening after a heart attack, either as part of a full review of systems or including it on a questionnaire before the doctor/patient meeting. Some centers incorporate discussion on sexual activity into their cardiac rehabilitation program, but that is not a reason for physicians to avoid the topic, because "many patients do not actually attend or complete cardiac rehab," cautioned Dr. Gulati. She also believes that medical school training, residency, and fellowship programs could help future doctors by training them in how to have these conversations.
PCPs appeared to be slightly more comfortable than cardiologists in encouraging patients to discuss stress from personal or family issues. A State of the Art paper on psychosocial risk factors from the Journal of the American College of Cardiology recommends open-ended questions to help screen for these, such as:
• What kind of pressure have you been under at work or at home?
• Are there any personal issues that we have not covered that you would like to share with me?
The paper advises that subclinical psychological distress -- such as minor depression, job stress, inability to relax, and trouble sleeping -- may be appropriately managed in a routine cardiac practice. Patients with significant psychological distress or behavioral maladjustment should be referred to the appropriate specialist for psychiatric counseling or treatment.
Shy in Talking About Sex Post-MI
(Enlarge Image)
Figure 3.
Patient vs physician initiation of discussions
Whereas nearly all physicians surveyed said that they initiate discussions on heart health with their patients, only about one half of them would initiate a discussion on sex after a heart attack.
Dr. Martha Gulati (The Ohio State University) was not surprised by these findings: "This is something most doctors are not well-trained in and are often uncomfortable asking. Nonetheless, this affects patients, [and it] can cause marital stress and major family issues if this isn't addressed," she said via email.
Indeed, data from the TRIUMPH registry show that sexual activity declines in the year after an MI for patients who do not receive specific advice on this topic from their doctors. Most of the patients in this study did not receive discharge instructions about resuming sexual activity; only one half of the 1274 men (47%) and one third of the 605 women did.
The AHA statement on sexual activity and CVD notes that sexual activity is reasonable 1 or more weeks after uncomplicated MI for patients free of symptoms during mild to moderate physical activity. But as Dr. Gulati noted, "How good are the [guidelines] if they aren't used and applied to patients?"
Because patients may be uncomfortable bringing up the subject, she suggested addressing it as a routine part of screening after a heart attack, either as part of a full review of systems or including it on a questionnaire before the doctor/patient meeting. Some centers incorporate discussion on sexual activity into their cardiac rehabilitation program, but that is not a reason for physicians to avoid the topic, because "many patients do not actually attend or complete cardiac rehab," cautioned Dr. Gulati. She also believes that medical school training, residency, and fellowship programs could help future doctors by training them in how to have these conversations.
PCPs appeared to be slightly more comfortable than cardiologists in encouraging patients to discuss stress from personal or family issues. A State of the Art paper on psychosocial risk factors from the Journal of the American College of Cardiology recommends open-ended questions to help screen for these, such as:
• What kind of pressure have you been under at work or at home?
• Are there any personal issues that we have not covered that you would like to share with me?
The paper advises that subclinical psychological distress -- such as minor depression, job stress, inability to relax, and trouble sleeping -- may be appropriately managed in a routine cardiac practice. Patients with significant psychological distress or behavioral maladjustment should be referred to the appropriate specialist for psychiatric counseling or treatment.
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