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Study of Patient Information after Percutaneous Coronary Intervention (SPCI): should prevention programmes become more effective?
Linnaeus University, Kalmar, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.ORCID iD: 0000-0002-0768-2484
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Department of Cardiology, Karlstad.
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2015 (English)In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 10, no 11, e1-e7 p.Article in journal (Refereed) Published
Abstract [en]


This cross-sectional observational study was designed to evaluate the uptake and outcome of patient education after percutaneous coronary intervention (PCI).

Methods and results:

A questionnaire containing 41 items was handed out to consecutive patients from randomly selected Swedish hospitals after PCI. Questions concerned the patient's attribution of the cause of the cardiac event, perception of the information provided by physicians and nurses, and a self-assessment of changes in lifestyle post PCI regarding tobacco, physical activity, food habits and stress. Replies were obtained from 1,073 patients (reply rate 67%). Non-modifiable risk factors (age, heredity) were attributed a higher rate as the cause of disease compared to modifiable factors (smoking, physical activity, food habits). Most patients (67%) perceived they were cured, and 38% perceived from the given information that there was no need to change their habits. A mere 27% reported that they still had cardiovascular disease and needed behavioural change. After PCI, 16% continued to use tobacco; half of these were offered smoking cessation support. In spite of an 80% referral rate to cardiac rehabilitation, one out of two patients did not enrol. Fewer than half were regularly physically active. Nutritional counselling was provided to 71%, but only 40% changed food habits. Stress management programmes were rarely provided.


Current preventive practice scarcely meets the challenge posed by the progress in modern invasive cardiology. The Study of Patient Information after percutaneous Coronary Intervention (SPICI) motivates an in-depth revision and adaptation of cardiac rehabilitation programmes in order to improve patient understanding of the disease, and to support greater compliance with a cardioprotective lifestyle.

Place, publisher, year, edition, pages
2015. Vol. 10, no 11, e1-e7 p.
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:uu:diva-233163DOI: 10.4244/EIJV10I11A223PubMedID: 24472705OAI: oai:DiVA.org:uu-233163DiVA: diva2:750734
Available from: 2014-09-29 Created: 2014-09-29 Last updated: 2015-09-22Bibliographically approved
In thesis
1. From Stenting to Preventing: Invasive and Long-term Treatment for Coronary Artery Disease in Sweden
Open this publication in new window or tab >>From Stenting to Preventing: Invasive and Long-term Treatment for Coronary Artery Disease in Sweden
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Coronary artery disease (CAD) is the leading cause of death worldwide. Treatment with coronary interventions, long-term treatment and life style changes can reduce symptoms and improve prognosis. The aim of this thesis was to investigate aspects of invasive treatment for multivessel coronary artery disease, and to investigate adherence to prevention guidelines one year after myocardial infarction.

 We used the national quality registry SWEDEHEART to collect data on long term treatment one year after myocardial infarction for 51 620 patients < 75 years of age. For 17 236 of the patients, we collected LDL-cholesterol measurements from SWEDEHEART and defined use of lipid lowering drugs from the Prescribed Drug Register. We developed a questionnaire for post-PCI-patients to investigate patients’ understanding of cause and treatment of coronary artery disease. For 23 342 PCI-patients with multivessel coronary artery disease, SWEDEHEART-data was linked to Swedish health data registries to determine one year outcome for patients undergoing incomplete vs. complete revascularization.

  Lipid control (LDL-cholesterol < 1.8 mmol/L) was attained by one in four patients one year after myocardial infarction, whereas blood pressure control (< 140 mmHg) was attained by two thirds of patients. Lipid and blood pressure control was lower for women but there was no gender difference in smoking cessation rate: 56 %. Over 90 % of patients were treated with a statin after myocardial infarction but treatment was intensified for only one in five patients with LDL-cholesterol above target.

The questionnaire study revealed that non-modifiable factors such as age and heredity were more often seen as cause of coronary artery disease than modifiable life style factors. Only one in five patients perceived CAD as a chronic illness, requiring life style changes.

Two thirds of PCI-patients with multivessel disease underwent incomplete revascularisation, and this was associated with a twofold risk for the combination of death, myocardial infarction and repeat revascularization up to one year, compared to patients who underwent complete revascularization.

We conclude that  long term treatment after myocardial infarction is suboptimal in relation to guideline recommendations. Assessment of patients’ views on CAD and better health education post PCI may facilitate life style changes. Further studies need to investigate whether complete revascularization will improve outcome for PCI-patients with multivessel disease.


Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 76 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1033
Coronary artery disease, guideline adherence, prevention, cholesterol treatment, lifestyle, percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Research subject
urn:nbn:se:uu:diva-233167 (URN)978-91-554-9051-5 (ISBN)
Public defence
2014-11-13, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (English)
Available from: 2014-10-23 Created: 2014-09-29 Last updated: 2015-01-23

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