Counseling lacking on sexual activity after MI

Most patients are not given advice about resuming sexual activity after a myocardial infarction (MI), and the counseling that is given does not often follow clinical guidelines, according to a new study.

Researchers in the United States and Spain performed a prospective, longitudinal study to examine differences between genders in baseline sexual activity, function, and physician counseling after an acute MI. Data on demographic characteristics, sexual partner status, and sexual activity and attitudes were collected by in-person interview at baseline; data on sexual activity, attitudes, function, and physician counseling and recommendations about sexual activity were assessed by telephone interview at 1 month. Study results were published online Dec. 15 by Circulation.

A total of 2,349 women and 1,152 men treated at 127 hospitals participated in the study. Patients were between 18 and 55 years of age with a median age of 48 years. Seventy-six percent of women and 92% of men reported that sex was somewhat or very important at baseline; these percentages were 73% and 92% at 1 month after acute MI. Overall, 12% of women and 19% of men said they had discussed sexual activity with a physician in the month after their acute MI. Most patients in the United States said that they had initiated the discussion, and most patients in Spain said that their physician had (P<0.001).

Of those who had discussed sex with their physicians, 32% said they were told they could resume sexual activity without restrictions and 68% said that restrictions were recommended. In the latter group, 35% reported that they were told to limit sex, 26% said they were told to take a more passive role, and 23% said they were told to keep their heart rate down. Practice guidelines currently state that patients who have had an uncomplicated acute MI can safely resume sexual activity soon afterward if they can tolerate mild to moderate physical activity, the authors noted.

Risk-adjusted analyses found that female gender (relative risk, 1.07; 95% CI, 1.03 to 1.11), age (relative risk, 1.05 per 10 years; 95% CI, 1.02 to 1.08), and lack of sexual activity at baseline (relative risk, 1.11; 95% CI, 1.08 to 1.15) were associated with not discussing sexual activity with a physician. Women in Spain were more likely to be counseled about post-MI sexual activity than men, while U.S. women were less likely to be counseled than men. Restrictions on sexual activity were significantly more likely to be recommended to Spanish women than to U.S. women (adjusted relative risk, 1.36; 95% CI, 1.11 to 1.66).

The authors noted that their study used self-reported data and that the sample size was too small to determine the effects of specific factors on sexual outcomes after acute MI. However, they concluded that counseling about sexual activity as recommended by current guidelines is frequently not provided to younger patients with acute MI. “Patients want permission from the cardiologist ‘who knows my heart best’ that resuming sex is safe,” the authors wrote. “Physicians could meaningfully narrow the gap between guidelines and practice by adding permission to resume sex to routine counseling about returning to work and exercise.”

The December 2013 issue of ACP Hospitalist has an expert Q&A about counseling patients on sex after MI.