Knowledge and Perceived Health Benefits of Percutaneous Transluminal Coronary Angioplasty among Patients with Coronary Heart Disease
The determination of the knowledge and perceived health benefits of Percutaneous Transluminal Coronary Angioplasty (PTCA) from the patient’s view of understanding helps to develop a holistic approach to health care.
The study aimed to assess the knowledge and perceived health benefits of PTCA and to find the association of knowledge with the perceived health benefits and demographic variables among the patients with Coronary Heart Disease (CHD).
Materials and Methods
A descriptive survey design was used and data were collected from 130 participants of cardiac wards of a tertiary care hospital, Karnataka, using structured knowledge questionnaire about PTCA and post-PTCA health benefits scale. Later a leaflet about PTCA was given to the participants. Subjects diagnosed with CHD and on the first post procedural day of PTCA were included in the study and patients with psychiatric disorders and medical disorders except diabetes mellitus and hypertension were excluded. Descriptive statistics was used to describe the sample characteristics, Chi-Square was used for association.
The mean age of the sample was 54 years, the mean knowledge score was 7.35±2.855 and 15.4%, 69.2% and 15.4% of the participants had good, moderate and poor knowledge respectively. The PTCA procedure was perceived as highly beneficial by 79.2% of participants and association was not found between knowledge and perceived health benefits of PTCA (p>0.05).
The study highlights the need for planning programs for continuing individualised health education on PTCA for the patients and their families to make changes in the patient’s wrong perception of health benefits after PTCA.
Katha Mukherjee, Leena Sequira, Charlet Jasmine Vaz, .KNOWLEDGE AND PERCEIVED HEALTH BENEFITS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY AMONG PATIENTS WITH CORONARY HEART DISEASE.Journal of Clinical and Diagnostic Research [serial online]2018 Dec[cited:2019 Jun 24] 12 LC01 - LC05
Coronary Heart Disease (CHD) is the prime cause of mortality in the Indian population. Cardiovascular mortality in Asian Indian population is increasing rapidly . CHD accounts for 1 in 7 deaths in the US, killing over 360,000 people a year . The American Heart Association for Heart Disease and Stroke Statistics updated the fact in 2010 that United States has the highest population (17.6 million) of CHD, including myocardial infarction (8.5 million) and angina pectoris (10.2 million). As per the Global Burden of Disease Study 2013 estimate, about 17.3 million deaths worldwide were related to CHD . Prevalence of CHD in some of the Indian states is, 7.58% in Karnataka and 12.5% in Kerala. The overall prevalence rate of CAD is 11.0% in Chennai and 7.54% in Kashmiri population. The overall rural and urban prevalence was 6.70% and 8.37% respectively, higher in males, and slightly lower in females. The prevalence of CHD in Vellore was 3.4% among rural men, 7.4% among rural women, 7.3% among urban men, and 13.4% among urban women in 2010-2012 [4-8].
A study to assess the perceived urgency and benefits of the elective Percutaneous Coronary Intervention (PCI) showed that the benefits the participants were expecting from PCI were more than the actual . A qualitative study was conducted to identify the understanding and beliefs influencing behaviour change among post-angioplasty patients. One of them derived was “failure in behavioural change related to physical limitations” that “nothing helps,” and the false belief that angioplasty “cures” CHD. The study concluded that insufficient knowledge is responsible from patients’ perspective that PTCA is curative procedure for CHD . A study conducted to evaluate the effectiveness of pre-procedural counseling program on knowledge regarding coronary risk factors revealed that participation in the intervention did not find any difference in knowledge improvement or reduction in risk factor prevalence . Above studies shows that there is a gap between actual and perceived benefits.
The present study was conducted to assess the knowledge and perceived health benefits of PTCA in order to prepare information leaflet on PTCA detailing the possible benefits, risk, medication, follow up, lifestyle modification after PTCA among the patients with CHD which may help to know actual benefits and prepare themselves for the future care.
Materials and Methods
A descriptive survey approach was used with the objective to assess the knowledge and perceived health benefits of PTCA and to find the association between the knowledge and perceived health benefits of PTCA with the demographic variables among the patients with CHD. The setting of the study was cardiac wards of a tertiary care hospital, Karnataka. Data collection was done from 10th January 2016 to 6th February 2016.
The sample size calculation was done by estimation of proportion using the formula,n=z2(1-α/2)×p (1-p)/d2
where z(1-α/2)=1.96, p=8.3%
Total 130 subjects diagnosed with CHD and on first post procedural day of PTCA were included in the study by purposive sampling technique. Patients with any psychiatric disorders and medical disorders except diabetes mellitus and hypertension were excluded from the study. The tools used for the study were demographic proforma, structured knowledge questionnaire about PTCA and perceived post-PTCA health benefits scale. The structured knowledge questionnaire consisted of 18 questions related to the risk factors, treatment, diet and complications of CHD and PTCA. Each question had four options and the correct option was scored ‘1’. The total score was 18, which was arbitrarily divided as good knowledge level (>10), moderate knowledge level (5-10) and poor knowledge level (<5) [Appendix-1] [12-14].
Perceived post-PTCA health benefits scale is a five point Likert scale which consisted of 24 items. The items were related to the subject’s physical limitation, disease perception and treatment satisfaction of PTCA. The options were ‘strongly agree’, ‘agree’, ‘uncertain’, ‘disagree’, ‘strongly disagree’ which were given a score of five (5), four (4), three (3), two (2), and one (1) respectively. Item number 3, 4, 5, 6, 7, 8 and 9 had reverse scoring as they were negative questions. The total score was 120, which was arbitrarily divided into low, moderate, and high benefits as 30-59, 60-89 and 90-120 respectively. The reliability of structured knowledge questionnaire about PTCA was checked by Split-half technique (r=0.83) and “perceived post-PTCA health benefits scale” was obtained by Cronbach’s alpha (r=0.80) [Appendix-2] [12-14].
Ethical clearance was obtained from the Institutional Ethics Committee of research setting (IEC 723/2014) and written informed consent was taken from the participants of the study. The data was collected by administering the tools to the patients during January 2016-February 2016. After knowing patients’ views about PTCA, leaflets were prepared to detail the possible benefits, risk, medication, follow up and lifestyle modification after PTCA and distributed to the patients attending cardiac outpatient department.
Collected data for each patient was entered in Statistical Package for Social Sciences (SPSS 16 version). Descriptive statistic was used to describe the sample characteristics, Chi-Square was used for association between the knowledge and perceived health benefits and selected variables of PTCA among the patients with CHD [15,16].
The data presented in [Table/Fig-1] shows that among 130 subjects (47.7%) were in the age group of 51-60 years having mean age of 54 years, majority (76.2%) were males, 35.4% had completed Pre university course level education, 27.7% of the subjects had their own service, most of them (87.7%) were married and 82.2% belonged to Hindu religion, 46.2% were suffering from hypertension and 33.1% were taking antihypertensive drugs, 52.3% of the subjects did not have health insurance. The data presented in [Table/Fig-2] shows that the mean scores of knowledge were 7.35±2.855 and 15.4%, 69.2%, and 15.4% were having good, moderate and poor knowledge. The [Table/Fig-3] shows that the mean percentage of knowledge in the area of treatment of PTCA was 43.72% and less in the area of complications of PTCA (36.9%).
Frequency and percentage distribution of sample characteristics of patients with CHD (n=130).
|Sample characteristics||Frequency (f)||Percentage (%)|
|Age in years|
|61 and above||27||20.8|
|Pre university course||46||35.4|
|No formal education||2||1.5|
Frequency and percentage distribution of knowledge score of patients who underwent PTCA (n=130).
|Knowledge||f||%||Maximum possible score||Mean||SD|
Area wise description of mean, standard deviation and mean percentage (n=130).
|Area||Maximum possible score||Mean||SD||Mean percentage|
|PTCA-risk factor and causes||5||1.907||1.08||38.14|
[Table/Fig-4] shows that 103 (79.2%) patients perceived high benefits and 27 (20.8%) patients perceived moderate benefits of treatment and no statistically significant association between knowledge and perceived health benefits of PTCA (p=0.429). [Table/Fig-5] shows an association between education and knowledge of PTCA (p<0.005). [Table/Fig-6] shows an association between education and perceived health benefits of PTCA (p<0.043).
Association between knowledge and perceived health benefits of PTCA among CHD patients (n=130).
|Variables||Good||Moderate||Poor||Df||χ2 (Fisher exact)||p-value|
|Perceived health benefits|
Association between knowledge and selected variables of CHD patient (n=130).
|Variables||Good||Moderate||Poor||df||χ2 (Fisher exact)||‘p’ value|
|Age in years|
|61 and above||2||22||3|
|Graduate and above||3||11||3|
|Pre University Course||10||25||11|
|No formal education||0||1||1|
Association between perceived health benefits of PTCA and selected variables of CHD patients (n=130).
|Age in years|
|61 and above||19||8|
|Graduate and above||10||7|
|No formal education||1||1|
Results of the present study showed that 15.4% of participants had good knowledge about PTCA and 79.20% and 20.80% of the patients perceived high and moderate benefits after PTCA respectively. There was no association between the knowledge and perceived health benefits of PTCA.
The findings of the study done by Fernandez R showed that 46% of the participants had adequate knowledge to identify the risk factors of CHD who underwent PTCA . The study conducted by Ozkan O et al., to determine the expected treatment benefits from the patient’s perspective before and after PTCA revealed that the patients had the wrong understanding of complete recovery from the diseases, before PTCA it was 88.3% and after PTCA was 48.3% . Another study to assess the patient expectations of the benefits of Percutaneous Coronary Revascularization (PCR) shows no significant correlation between age and the belief that PCR would prolong life or help to prevent myocardial infraction .
The knowledge about the risk of coronary heart disease was not adequate but they are overestimating the benefits of PTCA. The information leaflet detailing possible benefits, risk, medication, follow up and lifestyle modification after PTCA given will help in the proper understanding of PTCA procedure.
. Nag T, Ghosh A, Prevalence of cardiovascular disease risk factors in a rural community in West Bengal, India International Journal of Medicine and Public Health 2015 5(4):259-64. [Google Scholar]
. American Heart Association. Heart Disease and Stroke Statistics 2017 At-a-Glance. on-line at: http://www.heart.org/idc/groups/ahamahpublic/@wcm/@sop/@smd/documents/downloadable/ucm_491265.pdf. 2017 Mar [Google Scholar]
. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Heart disease and stroke statistics-2010 update. A report from the American Heart Association Circulation 2010 121(7):e46-e215. [Google Scholar]
. Mendagudali RR, Akka KD, Manjula R, Swati IA, Dayalaxmi TS, Ghattargi VC, Prevalence of coronary heart disease in a rural population of Bagalkot, Karnataka, India International Journal of Community Medicine and Public Health 2015 2(4):581-86. [Google Scholar]
. Krishnan MN, Zachariah G, Venugopal K, Mohanan PP, Harikrishnan S, Sanjay G, Prevalence of coronary artery disease and its risk factors in Kerala, South India: a community-based cross-sectional study BMC Cardiovascular Disorders 2016 16(1):12 [Google Scholar]
. Mohan V, Deepa R, Rani SS, Premalatha G, Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5) Journal of the American College of Cardiology 2001 38(3):682-87. [Google Scholar]
. Kamili M, Dar I, Ali G, Wazir H, Hussain S, Prevalence of coronary heart disease in Kashmiris Indian Heart Journal 2007 59(1):44-49. [Google Scholar]
. Oommen AM, Abraham VJ, George K, Jose VJ, Prevalence of coronary heart disease in rural and urban Vellore: a repeat cross-sectional survey Indian Heart Journal 2016 68(4):473-79. [Google Scholar]
. Faraz K, Philip GJ, Donna MB, Mouin SA, John AS, Perceptions of elective percutaneous coronary intervention in stable coronary artery disease: cross-sectional study BMJ 2014 349:1-13. [Google Scholar]
. Janey CP, John PA, Paul AP, Laura R, Patrick KL, Kathryn AB, Living with heart disease after angioplasty: A qualitative study of patients who have been successful or unsuccessful in multiple behaviour change NIH Public Access Author Manuscript 2010 39(2):105-15. [Google Scholar]
. Leigh RT, Kryss TM, Frikkie M, Pre-admission education/ counseling for patients undergoing coronary angioplasty: impact on knowledge and risk factors Australian and New Zealand Journal of Public Health 1998 28(5):583-88. [Google Scholar]
. Lewis SL, Bucher L, Heitkemper MM, Dirksen SR, Clinical Companion to Medical-Surgical Nursing-E-Book 2014 Jun 25 Elsevier Health Sciences [Google Scholar]
. Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald’s Heart Disease E-Book: A Textbook of Cardiovascular Medicine 2014 Jul 30 Elsevier Health Sciences [Google Scholar]
. Park K, Park K, Screening for disease Park’s textbook of Preventive and Social Medicine 2011 21st edJabalpurBhanot publishers:116-8. [Google Scholar]
. Wayne WD, Chad LC, Biostatistics A foundation for analysis in the health sciences 1995 6th edCanadaJohn Wiley [Google Scholar]
. Denise FP, Bernadette PH, Nursing Research principles and methods 2004 6th edPhiladelphiaLippincott [Google Scholar]
. Ritin SF, Yenna S, Rhonda G, Craig J, Patricia D, Awareness of risk factors for coronary heart disease following interventional cardiology procedures: A key concern for nursing practice International Journal of Nursing Practice 2008 14:435-42. [Google Scholar]
. Ozkan O, Odabası J, Ozcan U, Expected treatment benefits of percutaneous transluminal coronary angioplasty: the patient’s perspective The International Journal of Cardiovascular Imaging 2008 24(6):567-75. [Google Scholar]
. Eric HS, David AF, Elizebeth C, Michael R, Harlan MK, Perceptions of benefit and risk of patients undergoing first-time elective percutaneous coronary revascularization JGIM 2000 15:632-37. [Google Scholar]