Dorien Brouwer

99 Health education in patients with recent stroke or transient ischemic attack PART 2 and counselling intervention resulted in improved knowledge of CAD. [71, 72] A review of five studies investigating computer-software for education of patients with coronary heart disease demonstrated their effectiveness in increasing knowledge. The increased knowledge was demonstrated in patients who used the educational software immediately after the procedure. Only two of the five studies reported knowledge after six-months, with a large effect, using Cohen’s delta as effect size measure. [73] Loss to follow-up varied from 12% to 33%. [74] Attitude and skills Similar to stroke patients, it is important for patients to have knowledge of warning signs, so that they can quickly identify symptoms of acute coronary syndrome and take prompt action to seek care. Reperfusion therapy with either percutaneous coronary intervention or fibrinolytic drugs leads to lower case fatality and fewer complications. The case fatality of acute myocardial infarction is largely dependent on the time between symptom onset and reperfusion. [75] The main reasons for delay were the patients’ perception that the symptoms might pass, because the symptoms were either not severe, or because the patient thought that the symptoms were caused by a different illness. [76] Some studies found that better awareness of CAD symptoms was associated with shorter prehospital delay times [71, 72] but others did not. [77, 78] The Rapid Early Action Coronary Treatment trial, in which members of the community received education through the mass media and one-on-one approach from their local healthcare providers, showed limited success. [77] Despite an 18-month exposure to the intervention, time from symptom onset to hospital arrival for patients with chest pain did not change significantly, although appropriate use of medical emergency facilities was more frequently observed in the intervention communities. In another trial, participants (n53522) with documented CAD were randomized to experimental (n51777) or control (n51745) groups. Patients in the experimental groups received education and counselling about CAD symptoms and required actions. The education and counselling intervention did not lead to reduced prehospital delay or increased ambulance use. [78] However, short individual teaching and counselling intervention by a nurse resulted in improved knowledge of CAD and also in more appropriate responses to symptoms in people with a myocardial infarction sustained to 12-months. [71, 72] Health behavior and risk factor modification The EUROASPIRE III survey showed that large numbers of CAD patients do not achieve the desired lifestyle, risk factor modification and therapeutic targets for cardiovascular disease prevention. [79] Therefore, intervention trials with integrated HE are designed to achieve targets as defined in the prevention guidelines in routine clinical practice. In one trial, 3241 patients with recent myocardial infarction were randomized to a three-year