Coping with a heart attack: Psychological processes

In a substantial proportion of patients surviving a heart attack, their quality of life following discharge from the coronary care unit is less than optimal. For the greater part this less than optimal adjustment is not a function of illness severity. Rather, it would appear to reflect the operation of psychological and inter-personal factors involved in the adjustment process. Anxiety and depression are most clearly implicated in the rehabilitation process, with the affective responses being modulated by cognitive and relationship variables. However, not all cardiac patients are equally vulnerable, nor are they vulnerable in the same ways. Important issues that therefore need to be addressed by rehabilitation programmes are the early identification of individuals at particular risk for poor outcome, and the design of interventions that target specific risk factors.