Feedback on heart attack

The Royal Brompton & Harefield NHS Foundation Trust in London is the largest heart and lung centre in the UK. This article explores a project carried out by nurses at the trust looking at the experiences of having an acute myocardial infarction, and how patients felt about taking part in a research study.

Picture credit: Science Photolibrary

Having a heart attack is a terrifying experience for patients, but rarely do those treating them understand just how intensely painful it can be.

That is among the findings of new research looking at the experiences of having an acute myocardial infarction (MI), and how it then felt to take part in a research study.

‘When the patient first arrives at hospital, the paramedics have done such a good job that the person’s pain has subsided,’ explains research nurse manager Paula Rogers. ‘But many patients have an overwhelming feeling of how bad their pain was and are fearful of ever having it again. It can be so excruciating that the memory really stays with them.’

The lesson for healthcare staff at the Royal Brompton & Harefield NHS Foundation Trust is to allow patients to express their feelings about their pain. ‘It can be a frightening experience for those who are with them at the time, too,’ says Ms Rogers. ‘It’s a big deal to have to call 999. As healthcare professionals, coping with emergencies is something we take for granted, but it’s a very rare event for our patients.’

The trust, a partnership of two specialist hospitals, is the largest heart and lung centre in the UK, and is one of the biggest in Europe. Harefield Hospital near Uxbridge has pioneered the use of angioplasty to treat heart attacks, with around 900 patients each year receiving immediate angioplasty treatment. Harefield also has one of the fastest ‘arrival to treatment’ times in the UK – a critical factor in patients’ survival.

The research project was supported by the Patients First programme from the Foundation of Nursing Studies in partnership with the Burdett Trust for Nursing with a bursary of £5,000.

Running for seven years, the programme offers nurses, midwives and health visitors the opportunity to show how they are leading innovation and championing a practice culture where care is the best it can be.

‘Funding is hard to access for nurses,’ says Ms Rogers, who has been involved in research for over 20 years. ‘We didn’t need to use all the money but it certainly helped.’

Research focused on interviews with 11 patients who had been admitted to hospital with a heart attack. Each was interviewed four to six weeks after their discharge, between May and October 2014. To gather the experiences of staff, 22 members of the nursing team were also interviewed. While they appreciated the overall benefits of carrying out research, they also expressed some clear concerns.

‘They were nervous about the timing of the approach for consent,’ explains Ms Rogers. ‘Some were worried it may dilute some of the important discharge information for patients.’

Being in hospital for an average of three days leaves patients little time to come to terms with a life-changing event, or understand the changes that are key to their long-term recovery: medication, diet, exercise and controlling blood pressure and cholesterol.

‘It’s a fantastic unit with very compassionate staff. I think their biggest fear was that taking part in research would be a step too far for the patient,’ says Ms Rogers. In reality, every patient she approached willingly agreed to take part, and appreciated doing so, citing the chance to help patients of the future.

The research used an ‘emotional touchpoint’ method to gather information, which refers to the most significant aspects of an event. For a patient who has had a heart attack, these encompass the experience of chest pain, calling the emergency services, arriving at the hospital, the stent procedure, arriving on the ward, the research experience, preparing to go home and the impact of having had a heart attack. The approach generated interest when the findings were shared at the RCN International Nursing Research Conference last year, and at the European Society of Cardiology conference in London. ‘It is such an adaptable method, so can easily be transferred to other conditions,’ says Ms Rogers.

Coronary heart disease is the UK’s single biggest killer and the leading cause of death worldwide.

An estimated 915,000 people in the UK have survived a heart attack.

188,000 hospital episodes are attributed to heart attack in the UK each year – around one every three minutes.

Around seven out of ten people survive a heart attack.

Primary angioplasty is now the ‘gold standard’ treatment for patients who are suffering an acute MI, with 95% of these patients in England receiving this treatment in 2011-12, compared to just 27% in 2007.

Source: British Heart Foundation and the Royal Brompton & Harefield NHS Foundation Trust

The project identified that an extra discharge nurse could help make a real difference for patients. ‘There’s a lot of information to share, and it’s really critical to how patients respond once they get home,’ says Ms Rogers. ‘It’s such a stressful event that often the messages need to be explained and reinforced more than once, using different mediums.’

As one nurse commented in an interview: ‘Research interventions can have an impact on a smooth discharge process. Patients can become bombarded with information. Research nurses need to work closely with the discharge nurses so the important messages about going home aren’t lost in all the research information.’

The team is considering starting a project to see if patients retain discharge information.

In September 2015, the National Institute for Health and Care Excellence published quality standards on secondary prevention of heart attacks. These stress the importance of prompt cardiac rehabilitation to clinical outcomes, addressing the underlying causes of disease and improving physical and mental health.

A second benefit for staff has been improvements in working relationships between the acute cardiology unit and the catheter laboratory. ‘When we started, there was evidence of a little disharmony between the groups,’ says Ms Rogers. ‘But they had regular meetings throughout the project and relationships improved as the work continued.’ Now they have more mutual respect for each other’s work and understanding of the challenges each faces.

For Ms Rogers, one of the most important aspects of both the project and research generally is giving patients a chance to be part of the work. ‘Every patient is a potential participant in a research study, but rarely do we actually ask them what it’s like to take part,’ she says. ‘I believe that it’s an opportunity for them – and it’s not up to us to prejudge whether they will say yes or no. I really don’t mind if they do say no, but we need to approach them, or we are just adding our own bias’.

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