People 'needlessly avoid sex after heart attacks'

Thousands of heart attack survivors are too worried to have sex because they fear it will trigger another attack, the Daily Mail has reported today.

The story is based on a US study that looked at patients’ sexual activity both before their heart attack and in the year that followed. The study looked at the factors that affected whether people were still sexually active. It found that almost half of men and nearly 60% of women were less sexually active after a heart attack than previously, and that about one in ten who had been sexually active before a heart attack did not have sex in the year afterwards.

The study also found that only a third of women and 47% of men reported receiving any counselling about resuming sexual activity on leaving hospital. Those who had not received counselling were more likely to report reduced sexual activity in the following year. The study also found that patients who had sex in the year following a heart attack were no more likely to die than those who were sexually inactive, with mortality rates among both groups being similar.

Although it did not explore the reasons why some people were less sexually active after a heart attack, this study suggests that lack of any advice on the topic may leave patients fearing that sexual activity could put them at risk of a repeat heart attack, and that the issue needs to be addressed.

Most people value sexual activity as an important part of life, whatever their health. In the UK, the current advice is that anyone who has had a heart attack should be able to have sex without risk to their heart once they are fit enough to walk briskly up two flights of stairs without getting chest pains or becoming out of breath. This is usually about four weeks after having a heart attack. At this point, having sex will not put you at further risk of another heart attack.

Where did the story come from?

The study was carried out by researchers from the University of Chicago, the University of Missouri and Yale University. It was funded by the US National Heart, Lung and Blood Institute, and the non-profit corporation Cardiovascular Outcomes Inc. The study was published in the peer-reviewed American Journal of Cardiology.

The research was reported accurately in the Daily Mail, which pointed out that men having heart attacks during sex is rare, despite what “dramatic movie scenes” might suggest. To aid readers in the understanding of this complex medical issue the paper featured a run down of a famous coital heart attack on film, experienced by Jack Nicholson’s character Harry Sanborn in the film Something’s Gotta Give. The Daily Telegraph combined its report of the study with comments from a doctor explaining that TV programmes often mislead people into thinking heart attacks after sex are common. The doctor gave the examples of the TV shows Downton Abbey and Mad Men, which both “feature dramatic scenes where philandering men suffer heart attacks in bed”.

What kind of research was this?

This was an observational study that looked at sexual activity among 1,879 heart attack patients both before their heart attack and in the following year. It also looked at whether these patients received any instructions on the subject when being discharged from hospital, and whether any information provided covered sexual activity. Finally, it looked at any association between sexual activity and mortality rates within a year of having a heart attack.

What did the research involve?

The study, which was part of a larger study monitoring the health of heart attack patients, began in 2007. It included 1,879 patients (1,274 men and 605 women) who were followed for a year after they had been admitted to hospital with a heart attack.

Patients included in the study were first interviewed at the bedside by trained staff within 24 to 72 hours of the event, and the details gathered were added to information from their medical records. Data collected by the interviewers included information on income and social class, depression, severity of their disease and physical functioning.

Patients who took part in the sexuality study were interviewed by telephone at one month and 12 months after being enrolled. They were asked a series of questions including whether they had been sexually active in the year before having a heart attack, and whether they had had sex since having a heart attack (asked at both one and 12 months). Those who reported being sexually active before their heart attack were also asked whether they had had sex with more, less or the same frequency afterwards. 
Patients were also asked if they had received any instructions at hospital discharge about when to resume sexual activity, and whether they had discussed sex with their doctor during the period after being in hospital.

The researchers obtained mortality data on the patients through social security records at 12 months.

They analysed the findings to assess any factors associated with “loss of sexual activity” 12 months after heart attack.

What were the basic results?

The study featured 1,274 men and 605 women, with average ages of 58.6 years and 61.1 years, respectively. Researchers found that:

• Forty-four per cent of women and 74% of men were sexually active in the year before hospitalisation and 40% and 68% were sexually active afterwards.
• Of these groups, 48% of men and 59% of women reported less-frequent sexual activity in the 12 months after a heart attack.
• About one in 10 patients who were sexually active before their heart attack were not active in the subsequent year.
• One-third of women and 47% of men reported receiving hospital discharge instructions about resuming sex.
• Those who did not receive instructions were more likely to report loss of sexual activity (women, adjusted relative risk 1.44, 95% confidence interval 1.16 to 1.79; men, adjusted relative risk 1.27, 95% confidence interval 1.11 to 1.46).
• One-year mortality after heart attack was similar in those who reported sexual activity in the first month after their attack (2.1%) and those who were sexually inactive (4.1%). This suggests that whether or not people are sexually active has little bearing on their risk of death following a heart attack.

The study also found that men who had discussed sex with their doctor following their heart attack were less likely to be sexually active. The researchers say this could be because men who are anxious about having sex after a heart attack may be more likely to initiate a discussion with their doctor.

While nearly half of patients who were married and sexually active received no counselling about resuming sexual activity, two-thirds of unmarried patients who were sexually active, did not receive counselling.

Other factors such as age, marital status, depression and severity of heart disease were not associated with loss of sexual activity.

How did the researchers interpret the results?

The researchers conclude that, although many patients were sexually active before their heart attack, only a minority received counselling about resuming sexual activity at their discharge from hospital. Lack of counselling was associated with loss of sexual activity one year later. Mortality was not significantly increased in patients who were sexually active soon after their heart attack.

They say the study indicates that counselling may be an important factor in the likelihood of being sexually active after a heart attack, and that men and women can benefit equally.

They also argue that sexually inactive older adults with chronic illness value sexuality as an important part of life and that sexual inactivity before a heart attack should not exclude patients from receiving counselling in this area. “Profiling” patients for counselling based on previous sexual activity or on marital status, they argue, will exclude some patients who could benefit from this information.

Conclusion

This study had a number of limitations, including its reliance on patients recalling both their sexual activity in the year following their heart attack and also whether they received advice or counselling on the topic when discharged from hospital. This reliance on patients self-reporting past events could affect the reliability of the results, particularly as they were estimating these factors in the wake of a potentially life-changing heart attack.

Also, the researchers did not objectively measure whether it was patients or staff who initiated counselling on this topic at the time of discharge. Although counselling is likely to be initiated by hospital staff, it is possible that patients who were more interested in resuming sexual activity may also have been more likely to ask for counselling.

Previous research has already established the extremely low risk of a heart attack from having sex, and this study raises a number of important issues including a possible lack of medical advice causing heart attack patients to be anxious about resuming sexual activity. This is unlikely to be good for people’s sex life or their peace of mind as they recover.

Most people value sexuality as an important part of life, whatever their health. In the UK, the current advice is that anyone who has had a heart attack should be able to have sex without risk to their heart once they are fit enough to walk briskly up two flights of stairs without getting chest pains or becoming out of breath. This is usually about four weeks after having a heart attack for most patients. Having sex will not put you at further risk of having another heart attack, although you can speak to your doctor or read NHS Choices’ guide to sex after a heart attack if you require further information.