A total of 182 participants (mean age 59.9 years), who completed the baseline surveys were included in this study. Of these, 68.1% (n=124) were men and 87.9% (n=160) were white (). The majority of respondents had graduated high school and 25% reported completing college. Cardiovascular risk factors were common with over 40% of the subjects having a prior history of hypertension and/or hyperlipidemia. Diabetic patients comprised 19.3% of the study population. Approximately 30% of patients reported a prior history of heart disease. ST elevation myocardial infarction (STEMI) was the primary diagnosis for 32.2% of the study population, with a further 37.4% of patients admitted for a non-ST elevation myocardial infarction (NSTEMI), and the remainder admitted for elective angiography.
Baseline characteristics were then examined in relation to patient self-reported perceived quality of care. () Age, gender, ethnicity, education level and pre-existing co-morbidities did not differ for patients who reported poor to fair quality of care, good quality of care or very good to excellent quality of care. Patients who were admitted for an elective coronary angiography were more likely to report good or very good to excellent quality of care.
Baseline characteristics by perceived quality of Care
Few patients reported receiving advice on diet (40%) or exercise (30%) from their providers (). Overall, 41% of patients reported having no discussion on diet with anyone including healthcare providers (doctors, nurses and nurse practitioners) or family and friends. Approximately half of all patients reported having a discussion about exercise, most often with their physician. Patients who reported receiving advice from a healthcare provider regarding lifestyle (diet or physical activity) had similar baseline characteristics to those who reported not receiving such advice, with 2 exceptions. Patients with a history of hyperlipidemia or who were admitted for elective angiography were more likely to report having received lifestyle counseling from a provider.
Sources of medical advice by perceived quality of Care
Patients who perceived their quality of care as poor to fair were more likely to report having no discussion on diet (related to heart disease) as compared to patients who reported very good to excellent care (61% vs. 26%, p < 0.0001). Patients, who were satisfied with their care, reported having discussed diet and heart disease more often with family members and friends as well as with doctors and nurses. A similar pattern was observed between perceived quality of care and patients’ who reported having discussed their exercise habits with a healthcare professional. Those who reported higher levels of quality of care were more likely to report having such discussions with healthcare providers, and family and friends. In contrast, over 71% of those who reported poor to fair or good quality of care, reported having no discussion about exercise and heart disease, while only 36% of those who reported very good to excellent quality care reported no discussion on exercise.
We also asked patients to rate their confidence in making lifestyle modifications related to diet and physical activity. Overall, those who reported good, or very good to excellent quality of care had higher levels of confidence in their ability to modify their diet. Even in the group who reported poor to fair quality of care, the majority of respondents (57%) reported a high level of confidence for making dietary changes. A similar pattern was observed for patients’ confidence in improving their physical activity.
In terms of specific sources of information, the majority of patients reported their doctors as being a primary source of medical information (). However many patients reported magazines and newspapers as sources of information, and 25% of patients reported using the internet as a source of medical information. Overall, patients who reported poor to fair quality of care were less likely to use any of these resources, which included healthcare providers, family or friends and medial sources such as newspapers, internet or books.
Sources of medical information which patients feel comfortable using and perceived quality of care