Psychological Hazards of Convalescence Following Myocardial Infarction

Abstract

Three decades ago physicians commonly imposed a six-month convalescence upon patients recovering from myocardial infarction (MI). Since that time recommendations have undergone a liberal transformation. Not only has “early mobilization” become the aim for patients with an uncomplicated hospital course,¹ but those discharged are now expected to return to normal activities and employment much earlier than ever before. Indeed, for asymptomatic patients with uncomplicated coronary disease, Friedberg permits resumption of occupation after six weeks of convalescence.² Despite these liberal trends, there is a growing body of evidence to show that at least half the patients permitted to return to work are reluctant to do so and remain inactive for a prolonged period.If capable of work, why should a patient procrastinate? A number of authors have indicated psychosocial factors such as fear of recurrent infarction, anxiety, and depression.^5-8,11,12 In a more recent comprehensive review, Miller and Brewer¹¹ classify factors which influence progress in rehabilitation and cite psychological problems as heavy contributors to delayed convalescence.