Illness Representation, Fatigue, and Depressive Symptoms in Patients with Stable Coronary Disease

Coronary artery disease (CAD) is a chronic illness requiring secondary prevention for long term disease management. It is estimated that only 20% of eligible patients participate in secondary prevention programs, which has been shown to reduce future cardiovascular events. The purpose of this study is to identify the association among illness representation, fatigue, and depressive symptoms for secondary prevention behaviors in patients with stable CAD. Subjects (n=180) were recruited after coronary angiography and optimal medical therapy (OMT) (n=90) and percutaneous coronary intervention and optimal medical therapy (PCI/OMT) (n=90). The Illness Perception Questionnaire-Revised, Profile of Mood States, Short Form-36, and Patient Health Questionnaire-9 were administered at baseline and 30-days after treatment, with a response rate of 52.8% (n=95) at 30-days. Secondary prevention behaviors related to cardiac rehabilitation participation, smoking cessation, and medication use for antiplatelet and lipid lowering agents were collected using a health history update form. The findings revealed that illness representation influences secondary prevention for behaviors related to cardiac rehabilitation participation and the regular use of antiplatelet medications. Changes in illness representation were observed between the PCI/OMT and OMT treatment groups. Patients treated with OMT perceived their CAD diagnosis to be unpredictable and with less control by the prescribed treatment plan. Patients treated with PCI/OMT functioned from an acute illness model within 30-days after treatment. Gender differences in the symptom of fatigue were demonstrated, with females reporting higher levels of fatigue at baseline. There was no influence of fatigue and depressive symptoms for secondary prevention behaviors related to cardiac rehabilitation participation or aspirin and lipid lowering medications. Depressive symptoms were found to influence adherence to thienopyridine agents within 30 days after treatment. Shifts in illness representation occur within the first 30 days after treatment for stable CAD. A tailored approach for intervention-based research may help to improve the adoption of secondary prevention behaviors and help to improve long-term outcomes for patients living with CAD.