Introduction
Acute myocardial infarction is a complication of the heart that in which patients complain of heaviness or discomfort of the chest area. This complication is mainly as a result of a decrease in blood flow into the lungs or increase in perfusion. Diagnosis of this complication is done with great detail of the family history as well as physical examination to ascertain the levels of complication (Kapfhammer et al., 2004). In most cases, the treatment involves combating the possibility of re-infarction with much focus being given on the need to reduce any further damage of the cardiac tissue.
Treatment procedures in most cases have focused on cardiac rehab whereby the medical team stresses on the importance of decreasing chances of re-infarction through several strategies. Such strategies include the maintenance medication, patient education, family education, strategies for lifestyle modification as well as controlling related complications such as diabetes and hypertension. Statistics derived from a study by the World Health Organization in 2004, indicated that acute MI accounts for mort ham 17.1 million deaths every year. This is approximately 30% of the total death cases every year. However over the years, these statistics have been improved through adjustment of baseline variables so that the data reflects increasingly legible figures. This was necessitated by the need to differentiate between deaths resulting from Acute MI and those resulting from other acute coronary syndromes which had been previously classified together. In 2006 for instance, the number of deaths recorded by W.H.O as related to acute Mi was set at 14.2% of the total deaths worldwide (Kapfhammer et al., 2004). While being a lower figure that the previous recorded cases, the numbers still remain high.
The diagnosis and treatment procedures involved for acute MI mostly involved cardiac rehabilitation and post-traumatic stress disorder assessment and contorted. While the cardiac rehab has been widely acclaimed as an efficient tool in the control as well as the reduction of re-infarction cases, little focus has been given to the post-traumatic stress control. Patients who have undergone acute MI tend to develop post-traumatic stress disorders (PTSD) even under low anxiety levels. This puts them at risk of cardiac re-infarction as their cardiac tissues are rendered more prone to shock after the first infarction. Re-infarction resulting from PTSD is more disastrous as it places increased pressure on cardiac tissues that are already weakened by a past cardiac arrest (Pedersen et al., 2003). One of the most effective medical treatment or control methods for this disorder is the assessment of a patient’s psychological condition. This is done by placing the patients through a systematic program that seeks to help them handle future stressful conditions that would probably cause re-infarction.
Studies have shown that persistent PTSD cases after infarction tend to limit the chances of a patient’s survival and in most cases, facilitate further complication as well as death. These studies have shown that if PTSD persists for over three months later initial infarction the chances of survival or recovery are limited. Such evidence has necessitated the need for early intervention programs designed to handle post-traumatic stress disorders, as well as acute stress disorders, (ASD) (Ginzburg et al., 2002).
In recent years, medical teams have not been able to direct much focus on PSTD cases. Cardiac rehab techniques have been very effective. This has, however, come at the expense of follow-up programs designed to take care of the possible scenario of PSTD. There has been little effort directed towards psychological assessment and therapy treatments for such patients. This has been largely as a result of the failure to keep accurate records on a medical procedure for individual acute MI patients. Similarly, the healthcare systems have not been able to develop follow-up programs from these patients to assist them in formulating lifestyles that suit their health status. Psychological therapy programs for PSTD patients call for close-follow-up programs that can be useful in developing therapy programs to facilitate recovery. The follow-up programs should focus more on the psychological assessment of the patients (Spindler & Pedersen, 2005). The assessment results should be incorporated with past medical records of the patient to aid the medical team in developing effective strategies for the control of PSTD.
This paper seeks to dwell on the failure of current medical procedures on Acute MI patients which have placed greater concern on the cardiac rehab and placed less effort on the psychological assessment procedures to cater for PSTD cases. After the diagnosis and treatment for acute myocardial infection (MI) secondary prevention should be the primary objective of health care providers. Health care providers should focus on psychological therapy in their effort to prevent re-infarction in addition to cardiac rehabilitation (Pedersen et al., 2003). Studies show that medical teams focus on cardiac rehabilitation in their intervention to prevent re-infraction and overlook the significance of posttraumatic disorders on patients with acute myocardial infection. The paper will be guided by the thesis statement herein: Acute Myocardial Infarction (MI) patients should be assessed Post Acute MI for posttraumatic stress disorder. The focus of the paper is that the patients who have had acute MI get overlooked for posttraumatic stress disorders. Most of the time, focus in on cardiac rehab. This patient population gets overlooked for the psychological assessment. There is a need for an assessment tool developed by using technology in the healthcare information systems. Based on this thesis statement, the paper will seek to show the need for an assessment tool that can be applied in catering for PSTD cases.
With the current technological advancements, the healthcare sector should seek to optimize these advancements in medical procedures especially where a high level of accuracy is required. The discussion will be based on analysis of secondary literature as well as evidence from research studies to ascertain the efficacy of assessment programs. This will be gauged against the failure by the medical sector to implement strategies that can take care of psychological assessment programs for PSTD. The final part of the paper will dwell on analyzing the premise of the paper and developing a conclusive argument based on the guiding principles of the paper.
Premise
One of the major principles of healthcare facilities is to improve the patient outcome. This outcome is not limited to the physical well being of the patient. It extends to emotional, psychological as well as social well-being. Acute MI patients have been known to develop a low resistance to stress and anxiety conditions, and in effect placing their lives in a risky position. PSTD is a condition that needs to be handled with care because it places the patient in a position of greater risk (Kapfhammer et al., 2004). In most cases, PSTD patients tend to develop severe distress and increase mental perceptions of self harm. With this condition, there are lower chances of recovery. Cardiac therapy places focus on the physical well being of the patient by limiting the chances of injury to cardiac tissue. This is done through the application of reperfusion therapy techniques such as percutaneous coronary intervention and thrombolytic. These techniques have been highly effective in treatment and control of the complication.
However, there is more to this complication than just an application of cardiac rehab. The patients require a psychological assessment program that can be used to formulate a psychological therapy program for an individual patient. The assessment, however, requires a systematic approach that should incorporate the current condition of the patient, their family background and their past medical records. The purpose of these therapy programs is to facilitate the patient to regain their normal occupational lifestyles (Ginzburg et al., 2002). More focus is placed on placing the patient in less stressful environment which has been found to put them at risk of recurrent infarction. Together with the necessity of cardiac rehab procedures, it is important to note that these programs should be implemented simultaneously with the psychological assessment programs.
The simultaneous implementation of cardiac rehab and psychological assessment is based on the fact that an overlook of the patient’s psychological condition after infarction has a negative impact on their future survival or recovery. Most treatment procedures tend to overlook the efficacy of psychological assessment and therapy which has in most cases resulted to readmission at latter stages (Pedersen et al., 2003). The readmission rates have recorded higher mortality rates since patients are in a position of increased cardiac and mental complications.
Psychological therapy involves a set of procedures. Initially, the most important aspect is to place the patient in an environment that facilitates their recovery rather than limiting their ability to recover. A safe and controlled environment should be a priority. However, there is no doubt that this should be done in respect of the family’s preferences as well as the patient’s personal feelings. This imaginal exposure approach seeks to address the effects of the environment anxiety and stress levels. Limiting the anxiety and stress generated by the environment potentially reduces the chances of re-infarction (Pedersen et al., 2003). On the other hand, in-vivo exposure technique should be applied. This strategy seeks to confront the places, people and situations that could potentially lead to trauma in a controlled and systematic manner. The two approaches, imaginal exposure and in-vivo exposure focus on the population-based approaches designed to control psychological trauma. The third approach, cognitive exposure is an individual-based approach that seeks to identify and challenge any possible distorted thoughts and perceptions as well as interpretations about events that could potentially induce trauma (Pedersen et al., 2003).
Various studies have attested to the fact that a patient who has suffered from a life threatening illnesses such as myocardial infarction (MI) are at a greater risk of developing Post-traumatic stress disorder (PTSD).Similarly, various studies have been done to further explain the causes or the risk factors of MI-related post-traumatic stress disorder.
Research has converged at a common ground that various socio-demographic factor usually increase the risk of developing PTSD for patients with MI (Shemesh et al., 2004). For patients diagnosed with MI, post-traumatic stress disorder risk has significantly increased with unhealthy lifestyles and health behaviors such as smoking, low level of physical exercise and non-adherence to MI medications.
Myocardial infarction treatment should thus be followed with proper and relevant counseling procedures in order to cushion patients discharged from hospitals from PTSD. Apart from the medical approach to MI, counseling and psychological counseling has become a necessity since sizeable study and research shows that the often assumed post MI psychological therapy has cost many post MI patient’s lifetime psychological disturbances .Counseling and psychological therapy have been historically confined to non-trauma focused approach. However, evidence-based practice has identified the need to embrace the trauma-focused counseling and psychological therapy.
According to a study conducted by the Swiss National Science Foundation for 24 months on 426 eligible post-MI patients, it was established that a 45-minute counseling session for all the patients significantly reduced chances or severity of PTSD by 20% (Meister et al., 2013). The outcome of the therapy was conducted three months after the session of which the patients were assessed for PTSD symptoms.
This study is a typical exemplar of how post-MI counseling can prove fruitful in the treatment and management of PTSD. One of the strengths of the post-MI psychological therapy is that it minimizes chances of opportunistic conditions that are occasioned by increased fear and horror that develops after developing MI (Meister et al., 2013). Fear and horror among patients with MI has been found to increases levels of stress and depression. This may lead to the development of other more severe conditions such as diabetes and hypertension (Kapfhammer et al., 2004).
Myocardial infarction is characterized by weak cardiac muscles and thus any behaviors or psychological problem that strains the cardiac muscles may be a major suspect for deterioration of health conditions of a person who has suffered from MI .This being the sense; all factors such as stress that increase the rhythmic activity of the heart may be a major threat. It beats the logic of offering treatment for MI without a psychological therapy aimed at reducing stress levels. On the other hand, counseling and psychological therapy should be coupled with a lifestyle advice whereby individuals may be given tips to proper health behaviors .For instance, abstinence from smoking and alcohol consumption should be encouraged.
Counterargument
On the other hand, there has been a sizeable research that has ruled out the effectiveness of post-MI psychological therapy. Opponents of this medical approach have stated that since the muscles are already weakened by MI, there is no need for a technological approach in terms of offering post-MI therapy. Instead of investing in this course, patients should be put on medication that aims at strengthening the cardiac muscles. On the other hand, psychological therapy may have further negative influence on the response of drugs (Ginzburg et al., 2002). A psychological therapy may increase the trauma, fear levels of the patient, and subsequently increase stress levels. For instance, a patient may not perceive MI as a life-threatening condition. However, after introduction to post-MI therapy may increase the fear levels of the patient and as such start to perceive the condition as a threat to life.
In the recent past, research has pointed out the existence of other non-cardiac related problems that lead to PTSD. For instance, patients with bipolar diseases have shown symptoms related to PTSD. Therefore, physicians may offer treatment for conditions that may be not the primary course of stress. It is recommended that before opting for a psychological therapy it is important to dispel any chances of a bipolar disorder. A bipolar disorder may require the use of drugs and medicine and as such opting for a post-MI without checking the existence of other conditions may be deemed futile.
As much as medics and recent research has shown the importance of post-MI therapy, there should be a strong pre-therapy assessment of the patient to ensure its effectiveness. Bipolar disorders show symptoms that many times may be confused with symptoms presented by PTSD. Therefore, before offering a post-MI therapy patients should be cross-examined for bipolar disorders and the right medication offered. Coupled with a psychological therapy, physicians should advocate for dietary and lifestyle approach (Spindler & Pedersen, 2005). Diets that encourage healing of cardiac muscles should be recommended and lifestyles that increase risk levels be shunned.
Synthesis and conclusion
While there have been varying views on the importance of psychological assessments governed by technology, there is one principle that remains standing. The purpose of healthcare facilities is to ensure a positive outcome for the patient. This should not be limited to their physical well being. Instead, it should extend to the mental and psychological well being of acute MI patients. Thus, there is a need to ensure that healthcare facilities do not offer partial diagnosis and treatment for these patients considering that the re-infarction has been classified as having high mortality rates. A healthcare system that can handle a patient’s information from the initial treatment sessions to post-diagnosis period will be crucial in the development of a psychological assessment tool (Shemesh et al., 2004). The information is important in developing evidence-based practices that will enable the medical team to develop a comprehensive plan that takes care of the three approaches for psychological therapy discussed above. They include the imaginal exposure, in-vivo exposure and cognitive exposure.
References
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Meister, R., Princip, M., Schmid, J. P., Schnyder, U., Barth, J., Znoj, H., & Von Känel, R. (2013). STUDY PROTOCOL Open Access.
Pedersen, S. S., Middel, B., & Larsen, M. L. (2003). Posttraumatic stress disorder in first-time myocardial infarction patients. Heart & Lung: The Journal of Acute and Critical Care, 32(5), 300-307.
Shemesh, E., Yehuda, R., Milo, O., Dinur, I., Rudnick, A., Vered, Z., & Cotter, G. (2004). Posttraumatic stress, nonadherence, and adverse outcome in survivors of a myocardial infarction. Psychosomatic Medicine, 66(4), 521-526.
Spindler, H., & Pedersen, S. S. (2005). Posttraumatic stress disorder in the wake of heart disease: prevalence, risk factors, and future research directions.Psychosomatic Medicine, 67(5), 715-723.
