Knowledge and Perceived Health Benefits of Percutaneous Transluminal Coronary Angioplasty among Patients with Coronary Heart Disease
Katha Mukherjee1, Leena Sequira2, Charlet Jasmine Vaz3
1 Student, Department of Nursing, Manipal college of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India.
2 Principal, Department of Nursing, Manipal college of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India.
3 Lecturer, Department of Nursing, Manipal college of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Leena Sequira, Manipal College of Nursing, MAHE, Manipal-576104, Karnataka, India.
E-mail: leena.sequ@manipal.edu
Introduction
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.
Aim
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.
Results
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).
Conclusion
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.
Introduction
Coronary Heart Disease (CHD) is the prime cause of mortality in the Indian population. Cardiovascular mortality in Asian Indian population is increasing rapidly [1]. CHD accounts for 1 in 7 deaths in the US, killing over 360,000 people a year [2]. 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 [3]. 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 [9]. 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 [10]. 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 [11]. 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)/d2where 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.
Statistical Analysis
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].
Results
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 | | |
| 40-50 | 41 | 31.5 |
| 51-60 | 62 | 47.7 |
| 61 and above | 27 | 20.8 |
| Gender | | |
| Male | 99 | 76.2 |
| Female | 31 | 23.8 |
| Education | | |
| Graduate | 17 | 13.1 |
| Pre university course | 46 | 35.4 |
| High school | 45 | 34.6 |
| Primary school | 20 | 15.4 |
| No formal education | 2 | 1.5 |
| Religion | | |
| Hindu | 107 | 82.3 |
| Muslim | 8 | 6.2 |
| Christian | 15 | 11.5 |
| Current medication | | |
| Antiplatelet | 22 | 16.9 |
| Lipid-lowering drug | 36 | 27.7 |
| Diabetic drug | 26 | 20 |
| Nitroglycerin | 3 | 2.3 |
| Anti-hypertensive | 43 | 33.1 |
| Health insurance | | |
| Yes | 62 | 47.7 |
| No | 68 | 52.3 |
Frequency and percentage distribution of knowledge score of patients who underwent PTCA (n=130).
| Knowledge | f | % | Maximum possible score | Mean | SD |
|---|
| Good | 20 | 15.4 | | | |
| Moderate | 90 | 69.2 | 18 | 7.35 | 2.855 |
| Poor | 20 | 15.4 | | | |
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 |
| PTCA-treatment | 7 | 3.061 | 1.64 | 43.72 |
| PTCA-diet | 4 | 1.600 | 1.04 | 40 |
| PTCA-complications | 2 | 0.738 | 0.59 | 36.9 |
[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 |
| High benefits | 18 | 70 | 15 | 2 | 1.684 | 0.429 |
| Moderate benefits | 2 | 20 | 5 | | | |
Association between knowledge and selected variables of CHD patient (n=130).
| Variables | Good | Moderate | Poor | df | χ2 (Fisher exact) | ‘p’ value |
|---|
| Age in years | | | | | | |
| 40-50 | 7 | 25 | 9 | | | |
| 51-60 | 11 | 43 | 8 | 4 | 3.889 | 0.42 |
| 61 and above | 2 | 22 | 3 | | | |
| Gender | | | | | | |
| Male | 15 | 67 | 17 | 2 | 0.932 | 0.66 |
| Female | 5 | 23 | 3 | | | |
| Education | | | | | | |
| Graduate and above | 3 | 11 | 3 | | | |
| Pre University Course | 10 | 25 | 11 | | | |
| High school | 4 | 40 | 1 | 8 | 22.019 | 0.005 |
| Primary school | 3 | 13 | 4 | | | |
| No formal education | 0 | 1 | 1 | | | |
Association between perceived health benefits of PTCA and selected variables of CHD patients (n=130).
| Variables | High | Moderate | df | χ2 | p-value |
|---|
| Age in years | | | | | |
| 40-50 | 34 | 7 | | | |
| 51-60 | 50 | 12 | 2 | 1.704 | 0.42 |
| 61 and above | 19 | 8 | | | |
| Gender | | | | | |
| Male | 82 | 17 | | | |
| Female | 21 | 10 | 1 | 3.265 | 0.07 |
| Education | | | | | |
| Graduate and above | 10 | 7 | | | |
| P.U.C | 38 | 8 | | | |
| High school | 40 | 5 | 3 | 11.48 | 0.043 |
| Primary school | 14 | 6 | | | |
| No formal education | 1 | 1 | | | |
Discussion
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 [17]. 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% [18]. 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 [19].
Conclusion
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.
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