Illness Perceptions Predict Attendance at Cardiac Rehabilitation Following Acute Myocardial Infarction: a Systematic Review with Meta-analysis

Objective: Early reports indicated that the illness perceptions of patients following acute myocardial infarction (AMI) predict attendance at cardiac rehabilitation. However, null findings have subsequently been reported, and there is variation between studies in terms of which illness perception constructs predict attendance. The aim of this meta-analysis was to examine whether illness perceptions really predict attendance at cardiac rehabilitation and to examine factors that moderate this relationship.

Methods: The strategy and procedures recommended by Hunter and Schmidt [Hunter JE, Schmidt FL. Methods of meta-analysis: correcting error and bias in research findings. Thousand Oaks (CA): Sage, 2004] were followed. Based on a systematic literature search, eight studies (N=906 patients) that examined the relationship between illness perceptions and attendance at cardiac rehabilitation were included.

Results: Four illness perception constructs significantly predicted attendance at cardiac rehabilitation: patients with more positive identity (r=.123), cure/control (r=.111), consequences (r=.081), and coherence (r=-.160) beliefs were more likely to attend cardiac rehabilitation. For all relationships, except that between cure/control beliefs and rehabilitation attendance, there was significant heterogeneity, which was attributable to two studies: one that assessed illness perceptions after leaving the hospital yielded higher effect size estimates, whereas another that involved an intervention yielded effect size estimates in the direction opposite to those of most other studies. The exclusion of these studies resulted in largely unchanged, but homogeneous, effect size estimates.

Conclusion: Illness perceptions of AMI patients predict attendance at cardiac rehabilitation, although the effect sizes are small and often heterogeneous. AMI patients who view their condition as controllable, as symptomatic, and with severe consequences, and who feel that they understand their condition are more likely to attend.