Psychological consequences of myocardial infarction: a self-regulation perspective on health-related quality of life and cardiac rehabilitation.

The aim of this review was to gain insight into prevalence of and interventions targeted specifically at psychological distress and health-related quality of life (HRQL) after a myocardial infarction (MI). For this purpose, self-regulation theory was introduced as frame of reference. Psychological distress and a reduction in HRQL after an MI are prevalent and can, for some patients, be persistent. This can negatively influence secondary prevention efforts, adherence, return to work and progression of the underlying coronary heart disease. At the same time, the effectiveness of cardiac rehabilitation programmes in improving HRQL is inconclusive. By starting off from a theoretical framework, effective strategies can be either identified or developed. Self-regulation theory is concerned with the process of goal setting and goal attainment and offers a model for explaining well-being and quality of life. The usefulness of this theory is supported by empirical evidence. Psychological factors derived from this theoretical framework (e.g. higher order goal disturbance) are associated with psychological distress and HRQL in the short and medium term after an MI and should thus be the target of cardiac rehabilitation programmes.