Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys

Aims Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient's perspective. Methods and results In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit >= 6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour. Conclusion Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.

Automated summary

Despite the high use of cardioprotective medications, many patients with coronary heart disease still have inadequate risk factor control due to poor adherence to healthy lifestyles. Factors contributing to this include smoking habits, obesity, lack of physical activity, and patients' perception of illness. Patients who participated in cardiac rehabilitation programs showed more successful lifestyle modifications. Lack of self-confidence was identified as a major barrier to behavior change for healthier lifestyles.