'It's a huge emotional and psychological trauma they have been through," says Maura Byrne.
"For the first time they have seen death up next to them."
She is talking about the effects of having heart trouble - effects which go beyond the physical.
Since 2001 she has been running a seven-week cardiac rehabilitation lifestyle changes course in Castlebar for men and women referred by Mayo General Hospital.
They range in age from the mid-thirties upwards. "People who have heart problems often experience very difficult life changes," she says. "These include fear, dealing with stress and dealing with other people's reactions to them. Their self esteem goes down. They have to get used to role changes. Maybe they have to stop working.
"Men sometimes value themselves in relation to the job thing. Suddenly that's gone and they see themselves as being of less value.
"A lot of damage can be done to their self esteem based on their image of themselves. Maybe they were the strong people who made all the decisions - now they can't go out and get a bucket of coal."
The course deals with issues such as stress, assertiveness - it's hard to cut down on your workload if you're afraid to say no - relationships and self-image. Areas such as diet and exercise are covered in separate courses run by Ann Marie Brown, cardiac rehabilitation co-ordinator at Mayo General Hospital who initiated the idea of the lifestyle changes course.
In an evaluation conducted by the Western Health Board among people who had done the course, 94 per cent reported improvements in health and well-being and 86 per cent said they had less stress in their lives.
Among those who benefited from the course is Claremorris school principal Martin Casey.
"I had my bypass in 2001," he says. "I was 55. It came out of the blue."
After the bypass, "I felt a different attitude to myself. I always felt I could do anything. Whatever had to be done I could do it. Now there are things I reckon I can't do.
"You are not a patient anymore three months after that operation - the consultant has told you you are fine. But there's still a frailty, psychologically, emotionally. It carries its own stress."
The course helped him to deal with his stress, his fears and his feelings. Now he gives himself recognition for a job done well rather than focusing on the negative. And he has learned that a little selfishness can be good for your health. "When you are young you are told not to be selfish but you have to realise that a certain amount of selfishness is necessary."
The people who were on the course with him still meet once a fortnight themselves. "It's a kind of community where everybody knows where the other is coming from." Without the course ,"a lot of us would have been in trouble. We would have had our fears and anxieties heightened rather than reduced. To me anybody who didn't have the opportunity to do it would have been deprived."
Following its success in Castlebar, the course is being extended to all acute hospitals in the WHB region - University College Hospital, Galway (where it began a few weeks ago), Roscommon General and Portiuncula Hospital in Ballinasloe. More information on the course is available from Thelma Birrane, Health Promotion Service, WHB, St Mary's Hospital, Castlebar, Co Mayo. Tel: 094-9042266.