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Has having a heart attack become too easy?

, wondered that in the course of interviewing 20 patients with myocardial infarction (MI) to figure out .

"Whereas, historically, patients who survived myocardial infarction were placed on bed rest for 4 to 6 weeks and faced depression, bedsores, and sometimes lethal arrhythmias, patients now often leave the hospital after 24 hours," she wrote in an article as national correspondent for the New England Journal of Medicine.

One interviewee exclaimed how good he felt immediately after acute treatment, contrasting it to the flu, "which knocks you down for days or a week or two, the heart attack, once they do the thing, you're in good shape."

And if you don't identify as a sick person, why take medication?

"No offense to you, but if it ain't broke, don't break it," said another patient who decided not to take aspirin, statin, or ACE inhibitor, insisting that he felt fine.

Many others expressed similar aversion, based on potential for side effects, distrust of drugs, or a hope that they could rely on lifestyle change alone.

Faced with "instinctive nonbelief," what's a cardiologist to do?

Up to half of patients don't take medications as prescribed, and that's similar after an MI, noted Rosenbaum, a cardiologist at Brigham and Women's Hospital in Boston.

One solution could be boosting use of cardiac rehabilitation, she suggested.

"Rehabilitation programs create a social environment where one can simultaneously have cardiovascular disease and be healthy."

Another might be to bolster belief in benefit with intuitive explanations.

"When asked about the purposes of their medications in general, many participants answered vaguely, but many clearly articulated the purpose of their antiplatelet medication," citing some version of the "visually intuitive clogged-pipe analogy," Rosenbaum noted.

There's some evidence from trials like MI FREEE that adherence to antiplatelet medications is higher, she pointed out.

Perhaps such an evocative metaphor makes the medication feel important. Could the same be done for other key cardiovascular drugs?

"Since it seems unrealistic to expect patients to react emotionally to concepts such as decreasing oxygen demand or preventing cardiac remodeling, one option is to include a visual demonstration, during predischarge medication counseling, showing boggy, poorly functioning hearts and how beta-blockers or ACE inhibitors act to prevent that condition," Rosenbaum suggested. "Another approach might involve a video of someone experiencing the clinical consequences of heart failure."

That appeal to the desire for health could work better than just showing evidence of prolongation of life, she added, as "research shows that fear of chronic illness often trumps fear of premature death."

CardioBuzz is a blog for readers with an interest in cardiology.

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