Patients who were sexually active before suffering a heart attack were one and a half times more likely to recapture their sex lives if they received guidance on the topic before leaving the hospital, a new study finds.
While it's no surprise that sexual activity tends to decline slightly for both men and women during the year following a heart attack, or acute myocardial infarction (AMI), researchers found that many patients who said they did not get medical counsel prior to hospital discharge either unnecessarily delayed or refrained from sex.
In a survey of 1,879 heart attack patients, less than a half of men and roughly a third of women recall receiving instructions about when to safely return to sexual activity before leaving the hospital. After a year of follow-up, only 41 percent of men and 24 percent of women reported having a discussion with their doctor about sex since their heart attack.
Results from the study published today in The American Journal of Cardiology are in line with early findings presented at an American Heart Association conference in 2010. Lead author, Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medicine, said the study underscores the need for more doctors to address sex as an important part of overall physical function, even after a life-threatening event such as a heart attack.
"Doctors need to understand the significant role they play in helping AMI patients avoid needless fear and worry about the risk of relapse or even death with return to sexual activity," said Lindau, a renowned expert on helping women with complex illnesses maintain sexual function. "Receiving instructions, prior to hospital discharge, about resuming sex was a major predictor of whether patients resumed sexual activity in the year following AMI. For women, this was the only significant predictor. The discharging cardiologist has detailed knowledge of the patient's condition, has provided life-saving care and is best positioned to advise on the safety of engaging in physical activity, including sex."
Without counseling, patients are left to make their own, often flawed, assumptions about risk associated with sexual activity. Multiple studies have shown that sex puts less of a strain on the heart than people might think. Images from overly dramatic movie scenes and sensational news stories reinforce common misconceptions. In reality, only about 1 percent of all heart attacks occur during sex. Far less than 1 percent of heart attack survivors die due to a sexual encounter, according to other research.
"This study may help doctors address issues that they're traditionally reluctant to discuss," said study author, Harlan Krumholz, MD, professor of medicine and epidemiology and public health at Yale University School of Medicine. "We're showing that addressing sexual health may make a difference to long-term outcomes."
Current guidelines developed by groups of leading cardiologists, including Krumholz, state that stable heart patients without complications can resume sexual activity with their usual partner within one week to 10 days. In January, the American Heart Association (AHA) put more weight behind those recommendations with its most comprehensive review to date of research on sexual activity among heart patients. The report substantiated a longstanding rule of thumb: If patients can engage in moderate exercise – such as walking up a couple of flights of stairs – they are generally healthy enough for sex. The AHA also points to respected guidelines for care after AMI, which include patient counseling on resuming sexual activity.
"The goal is to restore a patent's whole health," said John Spertus, MD, of the University of Missouri in Kansas City, who designed the study. "That means not only minimizing further progression of coronary disease, but also maximizing quality of life."
The researchers said doctors should resist making assumptions about which patients value their sexual lives. "The study shows that most male and nearly half of female heart attack patients are sexually active," Lindau added, "and previous work has shown that even sexually inactive patients still view sexuality as relevant for health and overall quality of life."
Lindau, Krumholz, Spertus and their colleagues are now honing in on the female patients in this study to understand how to improve sexual outcomes after an AMI.
Additional authors of the study include Paul S. Chan, MD, from the University of Missouri, Kansas City; Erica S. Spatz from Yale University; and Emily Abramsohn, MPH and Kristen Wroblewski, MS, from the University of Chicago Medicine.
This study was supported by grants from the National Heart, Lung and Blood Institute; Cardiovascular Outcomes Inc.; and the National Institute on Aging.
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