Many High-Risk Patients See No Need to Modify Unhealthy Lifestyle

So doctors and hospitals don't want to do the hard work of solving these problems. They would rather throw up their hands in defeat and blame the patient.  As Defense Secretary Donald H. Rumsfeld said 'You go to war with the army you have---not the army you might want or wish to have at a later time.'
Paraphrased for stroke patients, 'You go to the hospital with the patients you have, not the perfect ones that match the clinical trials'.
https://www.medpagetoday.com/Cardiology/Prevention/65006?

But seeing room for change generally correlated with level of risk

• by Nicole Lou
  Contributing Writer, MedPage Today May 03, 2017

People with unhealthy habits generally know they should change, although 1 in 5 of the highest-risk patients endorsed no need to do so, a Canadian population-based study found.
In general, having more potentially modifiable risk factors correlated with an individual's perceived need to improve his or her health (adjusted prevalence ratio [PR] 1.08 for every additional risk factor, 95% CI 1.07-1.09), according to Benjamin Hibbert, MD, PhD, of Canada's University of Ottawa Heart Institute, and colleagues.
Of those at highest cardiac risk (with five risk factors or more), 82.3% agreed that they should improve their health when responding to the 2011-2012 Canadian Community Health Survey.
"A substantial proportion of individuals at risk for cardiovascular events do not feel a need to improve their physical health, indicating an urgent need to identify means to modify public health perceptions and behaviors," Hibbert's group concluded.
Moreover, they added, "a better understanding of factors underlying health perceptions and behaviors is needed to capitalize on cardiovascular preventive efforts."
The investigators got survey results from 45,443 respondents for the present analysis.
On multivariable adjustment, the risk factors most likely to coax people to want to improve their health were:

• Smoking (adjusted PR 1.14, 95% CI 1.10-1.18)
• Obesity (adjusted PR 1.17, 95% CI 1.13-1.22)
• Low physical activity (adjusted PR 1.13, 95% CI 1.10-1.17)
• High stress (adjusted PR 1.09, 95% CI 1.05-1.12)
• Low fruit and vegetable consumption (adjusted PR 1.06, 95% CI 1.03-1.09)

Also related to a desire to improve one's health were the characteristics of younger age, female sex, education, and household income of at least $40,000. However, hypertension, diabetes, and excessive alcohol intake did not correlate with desire to improve daily habits.
Barriers to adopting healthy behaviors were reported by 55.5% of those who said they should improve their health. Common barriers included self-discipline, work schedule, and family responsibilities (cost, stress, lack of available resources, and transportation were each cited only 5% of the time)
A weakness of the study: "The outcome variable selected is inherently imperfect and likely failed to capture important nuances in health perceptions," Hibbert's group acknowledged.

Hibbert and colleagues disclosed no conflicts of interest.

• Primary Source

  Journal of the American Heart Association

  Source Reference: Ramirez FD, et al "Association between self-reported potentially modifiable cardiac risk factors and perceived need to improve physical health: a population-based study" J Am Heart Assoc 2017.