Open Access Open Access  Restricted Access Subscription or Fee Access

Effects on self-management behaviour after an individual nurse-led counselling programme for patients discharged early after myocardial infarction: A 12-month randomised controlled follow-up

Gunhild Brørs, Tone M Norekvål, Liv Heidi Skotnes, Ulla Romild, Bengt Fridlund


Rationale, aims and objectives: Secondary prevention programmes reduce cardiovascular risk, but few studies have evaluated whether a nurse-led intervention for patients discharged early after myocardial infarction (MI) promotes self-management behaviour. The aim of this study was to evaluate the effect of an individual nurse-led counselling programme combined with usual care versus usual care alone on self-management behaviour of patients discharged early after MI.

Methods: Seventy-one patients were randomised to either the usual care (control group) or to the usual care combined with a 6-month follow-up individual nurse-led counselling programme (intervention group). The latter consisted of 3 face-to-face sessions and 2 telephone contacts over 6 months, starting 2 weeks after discharge. Primary outcome measures at 6- and 12-month follow-up was the difference in self-management behaviour assessed by the patient activation measure (PAM). Secondary outcomes included physical activity and diet habit.

Results: The median age of patients was 63 years and 70% were males. The intervention group had a greater effect on their PAM scores and had higher average intensity and longer duration of physical activity at 6-months and a higher summary index of weekly physical activity at 6- and 12-month follow-up compared to the control group. There was a clinically relevant effect on diet score within the intervention group at 6- and 12-month follow-up.

Conclusions: An individual nurse-led counselling programme combined with usual care for post-MI treatment, had an effect on self-management behaviour at 6-month follow-up. The results also indicate an effect on health behaviour at 12-month follow-up.


Counselling, health behaviour, myocardial infarction, nurse-led, person-centered healthcare, randomised controlled trial, self-management

Full Text:



Piepoli, M.F., Hoes, A.W., Agewall, S. et al. (2016). 2016 European guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 37 (29) 2315-2381.

Kotseva, K., Wood, D., De Bacquer, D. et al. (2016). EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. European Journal of Preventive Cardiology 23 (6) 636-648.

Piepoli, M.F., Corra, U., Benzer, W. et al. (2010). Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. European Journal of Cardiovascular Prevention and Rehabilitation 17 (1) 1-17.

Steg, P.G., James, S.K., Atar, D. et al. (2012). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal 33, 2569-2619.

Boyde, M., Grenfell, K., Brown, R., Bannear, S., Lollback, N., Witt, J., Jiggins, L. & Aitken, L. (2015). What have our patients learnt after being hospitalised for an acute myocardial infarction? Australian Critical Care 28 (3) 134-139.

Falun, N., Fridlund, .B., Schaufel, M.A., Schei, E. & Norekval, T.M. (2016). Patients' goals, resources, and barriers to future change: A qualitative study of patient reflections at hospital discharge after myocardial infarction. European Journal of Cardiovascular Nursing 15 (7) 495-503.

Leino-Kilpi, H., Heikkinen, K., Hiltunen, A., Johansson, K., Kaljonen, A., Virtanen, H. & Salanterä, S. (2009). Preference for information and behavioral control among adult ambulatory surgical patients. Applied Nursing Research 22 (2) 101-106.

Ghisi, G.L.M., Abdallah, F., Grace, S.L., Thomas, S. & Oh, P. (2014). A systematic review of patient education in cardiac patients: Do they increase knowledge and promote health behavior change? Patient Education and Counseling 95, 160-174.

Dullaghan, L., Lusk, L., McGeough, M., Donnelly, P., Herity, N. & Fitzsimons, D. (2014). 'I am still a bit unsure how much of a heart attack it really was!' Patients presenting with non ST elevation myocardial infarction lack understanding about their illness and have less motivation for secondary prevention. European Journal of Cardiovascular Nursing 13 (3) 270-276.

Nilsson, U.G., Ivarsson, B., Alm-Roijer, C. & Svedberg, P. (2013). The desire for involvement in healthcare, anxiety and coping in patients and their partners after a myocardial infarction. European Journal of Cardiovascular Nursing 12 (5) 461-467.

Fors, A., Taft, C., Ulin, K. & Ekman, I. (2016). Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. European Journal of Cardiovascular Nursing 15, 186-194.

Hibbard, J.H., Mahoney, E.R., Stock, R. & Tusler, M. (2007). Do increases in patient activation result in improved self-management behaviors? Health Services Research 42 (4) 1443-1463.

Allen, J.K. & Dennison, C.R. (2010). Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: systematic review. Journal of Cardiovascular Nursing 25 (3) 207-220.

Jorstad, H.T., von Birgelen, C., Alings, A.M., Liem, A., van Dantzig, J.M., Jaarsma, W., Lok, D.J., Kragten, H.J., de Vries, K., de Milliano, P.A., Withagen, A.J., Scholte, O.P., Reimer, W.J., Tijssen, J.G. & Peters, R.J. (2013). Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial. Heart 99 (19) 1421-1430.

Hanssen, T.A., Nordrehaug, J.E., Eide, G.E. & Hanestad, B.R. (2007). Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention. European Journal of Cardiovascular Prevention and Rehabilitation 14 (3) 429-437.

Jiang, X., Sit, J.W. & Wong, T.K. (2007). A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. Journal of Clinical Nursing 16 (10) 1886-1897.

Zhao, Y. & Wong, F.K. (2009). Effects of a postdischarge transitional care programme for patients with coronary heart disease in China: a randomised controlled trial. Journal of Clinical Nursing 18 (17) 2444-2455.

Strandberg, E.L., Ovhed, I., Borgquist, L. & Wilhelmsson, S. (2007). The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study. BMC Family Practice 8, 1-8.

Schadewaldt, V. & Schultz, T. (2011). Nurse-led clinics as an effective service for cardiac patients: results from a systematic review. International Journal of Evidence-Based Healthcare 9 (3) 199-214.

Ekman, I., Swedberg, K., Taft, C., Linseth, A., Norberg, A., Brink, E., Carlsson, J., Dahlin-Ivanoff, S., Johansson, I.L., Kjellgren, K., Lidén, E., Öhlén, J., Rosén, H., Rydmark, M. & Sunnerhagen, K.S. (2011). Person-centered care - ready for prime time. European Journal of Cardiovascular Nursing 10 (4) 248-251.

Bodenheimer, T., Lorig, K., Holman, H. & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. Journal of the American Medical Association 288 (19) 2469-2475.

Lorig, K.R. & Holman, H. (2003). Self-management education: history, definition, outcomes, and mechanisms. Annals of Behavioral Medicine 26 (1) 1-7.

Clark, N.M. & Houle, C.R. (2009). Theoretical models and strategies for improving disease management by patients. In: The Handbook of health behavior change. Shumaker, S.A., Ockene, J.K. & Riekert, K.A. (eds.). pp. 19-37. New York: Springer Publishing Company.

Hibbard, J.H., Mahoney, E.R., Stockard, J. & Tusler, M. (2005). Development and testing of a short form of the patient activation measure. Health Services Research 40 (6 Pt 1) 1918-1930.

Steinsbekk, A. (2008). Patient Activation Measure. Tidsskr Nor Laegeforen 128 (20) 2316-2318.

Wensaas, L. (2012). Effects of a decision aid with and without additional dicisional counseling for patients being examined for coronary artery disease on cardiac risk reduction behavior and health outcomes. A randomized controlled trial (A philosophiae doctor degree). University of Oslo: Oslo.

Polit, D.F. & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Wolters Kluwer Health.

Svilaas, A., Strom, E.C., Svilaas, T., Borgejordet, A., Thoresen, M. & Ose, L. (2002). Reproducibility and validity of a short food questionnaire for the assessment of dietary habits. Nutrition, Metabolism & Cardiovascular Diseases 12 (2) 60-70.

Kurtze, N., Rangul, V., Hustvedt, B.E. & Flanders, W.D. (2008). Reliability and validity of self-reported physical activity in the Nord-Trondelag Health Study: HUNT 1. Scandanavian Journal of Public Health 36 (1) 52-61.

Cohen, J. (1992). A power primer. Psychological Bulletin 112 (1) 155-159.

Altman, D.G. (1991). Practical statistics for medical research. London: Chapman and Hall.

Harvey, L., Fowles, J.B., Xi, M. & Terry, P. (2012). When activation changes, what else changes? the relationship between change in patient activation measure (PAM) and employees' health status and health behaviors. Patient Education and Counseling 88 (2) 338-343.



  • There are currently no refbacks.