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Sexual activity declines post-MI in patients lacking advice

American Heart Association Scientific Forum on Quality of Care and Outcomes Research; 19–21 May 2010: Washington, DC

Sexual activity declines in the year after suffering an acute myocardial infarction (MI) in patients who do not receive instruction on when it is safe to resume sex, researchers have reported.

Less than half of male and around one third of female MI patients in their study reported receiving discharge instructions on resuming sexual activity; even fewer patients – less than two-fifths of the men and one-fifth of the women – talked about sex with their physicians in the year following their MI.

"Sexual activity is an important part of life throughout life, and most heart attack patients are sexually active," said lead investigator Stacy Tessler Lindau, from University of Chicago, Illinois, USA. "For the most part, physicians just aren’t discussing this topic with their patients after a heart attack."

Lindau reported the findings at the American Heart Association’s Scientific Forum on Quality of Care and Outcomes Research, held in Washington, DC. The study, part of TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery from acute MI: Patients’ Health Status), included 1184 men (mean age 59 years) and 576 women (mean age 61 years) who had suffered an acute MI.

Most were assessed at 1 month and again at 1 year after the index event regarding their level of sexual activity and communication before and after the MI. At 1 year, men were more likely than women to report having received discharge instructions about resuming sexual activity (46.3% vs 34.5%, p<0.001) and having discussed sexual activity with their physician in the year following MI (38.8% vs 17.5%, p<0.001).

Analysis showed that men were 1.3 times and women 1.4 times more likely to report a loss of sexual activity after 1 year if they had not received information on when to resume sexual activity. This was after adjusting for the fact that the men were more likely to be married and more likely to be sexually active before the MI than the women, as well as age, GRACE 6-month mortality risk score, depression, and physical health at baseline.

Lindau also noted that, even when patients reported receiving instructions on resuming sexual activity, it remained unclear exactly how and what information was delivered. "We don’t yet know the content or value of the instructions patients are receiving," she said.
The consensus among physicians is that it is safe to resume sexual activity after MI once the patient feels better and is able to perform moderate exercise. "The likelihood of dying during sexual intercourse… is really small," Lindau said.

She added that physicians need to bring up the subject, even if not as part of the routine discharge check list. Emphasizing that further study is needed, Lindau nevertheless said that physicians "need to be proactive and help patients recover their whole lives after heart attack," and as part of this should "assess a patient’s sexual history to ensure all aspects of a patient’s physical and emotional well-being are addressed."

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