Clinical features of ischemic heart disease and modes of subjective perception of illness

The sample included 91 inpatients with different clinical forms of ischemic heart disease (IHD) and modes of subjective perception of illness (subject ive meaning of illness). Prichard's Reaction to Illness Questionnaire, Hosp ital Anxiety and Depressive Scale, Rotter's Internal-External Control Scale and Illness Locus of Control Scale (Bevz I.A.,1998) were used on day 14 af ter admission for qualification of the patient's subjective perception of i llness. The following clinical predictors of hypernosognia (inadequately hi gh subjective significance of illness) were revealed: 1) the onset of IHD i n midlife (<65 years) with its subsequent fast progression including high i ncidence of recurrent coronary events and/or congestive heart failure, 2) " typical" and protracted angina pectoris, 3) cardiac arrhythmias accompanyin g persistent high heart rate (sinus tachycardia, chronic atrial fibrillatio n, frequent extrasystoles) and defying any self-care, and 4) severe heart f ailure. On the other hand clinical predictors of hyponosognosia (inadequate ly low subjective significance of illness) included 1) the onset of IHD in elderly individuals (>65 years) and its subsequent slow progression without recurrent coronary events and/or congestive heart failure, 2) the socalled "anginal syndrome" (lack of angina's coupling with psychical exertion, aty pical pain location, inconstant efficiency of nitroglycerin) and silent myo cardial ischemia, 3) the paroxysmal cardiac arrhythmias (infrequent extrasy stoles, paroxysmal atrial fibrillation, supraventricular tachyarrhythmias) with normal or slow heart rate between the paroxysms and high efficiency of self-care, and 4) mild to moderate heart failure. The findings are discuss ed in terms of prediction of specific modes of subjective perception of ill ness and its practical implications for correction of patient's attitude to his/her disease, correction of non-compliance, optimization of therapeutic al alliance and use of heart care resources.