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Changes in Patient Drawings of the Heart Identify Slow Recovery After Myocardial Infarction

From the Departments of Psychological Medicine (E.B., K.J.P.) and Medicine (G.G.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; and Auckland City Hospital (C.J.E.), Auckland, New Zealand.

Address correspondence and reprint requests to Elizabeth Broadbent, PhD, Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail: e.broadbent{at}auckland.ac.nz

Objective: The objective of this study was to investigate how changes in heart attack patients’ drawings of their heart over the recovery period relate to psychological and functional recovery.

Methods: Sixty-nine inpatients admitted for acute myocardial infarction at the coronary care unit at a metropolitan hospital completed questionnaires at discharge, including a drawing of what they thought had happened to their heart after their heart attack. Fifty-six patients returned follow-up questionnaires at 3 and 6 months, including heart drawings, cardiac anxiety, time to return to work, changes in exercise frequency, and healthcare use.

Results: Increases in the size of the heart drawn at the 3-month follow-up relative to discharge were related to slower return to work (r = 0.48, p < .01), higher cardiac anxiety (r = 0.35, p < .05), and more phone calls to health services (r = 0.37, p < .05) as well as increases in worry about another myocardial infarction (r = 0.39, p < .01), increased activity restriction (r = 0.34, p < .05), higher use of alternative medicines (r = 0.40, p < .05), and less frequent exercise (r = –0.39, p < .05) relative to before the myocardial infarction.

Conclusions: Drawings of the heart may be useful in identifying patients who have experienced heart attacks who are likely to develop greater heart-focused anxiety, complaints of ill health, and higher use of health care. Increases in the size of the patient’s drawing of the heart may reflect increases in the extent to which their heart condition plays on their mind and directs their daily activities.

Key Words: myocardial infarction • drawings • cardiac anxiety • recovery • perceptions

Abbreviations: MI = myocardial infarction; CAQ = Cardiac Anxiety Questionnaire.