The relationship between the psychological status of patients who have undergone myocardial revascularization and exercise tolerance at the outpatient stage of rehabilitation (original article)

Background. In modern conditions of combating cardiovascular mortality, there are problems of patient’s weak motivation and low involvement in cardiac rehabilitation (CR) programs.

Objective. Determination of the relationship between the psychological status of patients who underwent myocardial revascularization and exercise tolerance at the outpatient stage of rehabilitation.

Methods. The open clinical trial included 85 patients (66 men and 19 women) 1 month after coronary revascularization, who had previously completed the first and/or second stages of CR and were referred to the outpatient stage. The age of the patients ranged from 42 to 79 years, mean age 60.8±7.23 years. Two groups were identified: 1st – 35 (41.18%) patients who underwent percutaneous transluminal coronary angioplasty (PTCA); 2nd – 50 (58.82%) patients after coronary artery bypass grafting (CABG). Under standard conditions, a face-to-face survey using “Hospital Anxiety and Depression Scale” (HADS, anxiety subscale HADS-A, depression subscale HADS-D), short form of quality of life assessment “SF-36” was conducted. In order to determine exercise tolerance, a six-minute walk test (SMWT) was performed.

Results. When studying correlation relationships, an inverse relationship was revealed between SMWT distance and age (r=-0.407; p=0.001), HADS-A (r=-0.443; p=0.000), HADS-D (r=-0.356, p=0.003), direct relationship with the Mental Health indicator (r=0.269; p=0.027), integral indicators of the “physical component of health” (r=0.266; p=0.029) and the “mental component of health” (r=0.327; p=0.007).

Conclusion. The psychological status of the patient can influence the SMWT distance, which plays an important role in the development of individual CR programs after coronary revascularization at the outpatient stage. This fact leads to defects in the selection of optimal physical activity when drawing up a physical training protocol. The combined use of two scales (HADS and SF36) contributes to a deeper assessment of the patient’s initial psychological status, which makes it possible to recommend early inclusion of a psychologist or psychotherapist in a multidisciplinary team to correct disorders.