Dynamics of parameters of psychological status of patients with stable ischemic heart disease and coronary artery bypass surgery

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Abstract


Aim. Assessment and analysis of parameters of psychological status of patients with coronary heart disease (CHD) referred for coronary artery bypass surgery (CABG).

Materials and Methods. A study of parameters of psychological status, in particular, of the attitude to illness, coping strategies, and lifelong orientations was conducted in 58 male patients aged 40 to 74 years with a stable form of CHD before and after CABG surgery. The parameters were evaluated by a clinical psychologist in 2-3 days after admission of the patient to the hospital and in 7-8 days after CABG. Clinical and psychological diagnostics was carried out using the following questionnaires: TOBOL (L.I. Wasserman, et al.), «Life-Purpose Orientations» (D.A. Leontiev), «Coping Behavior Strategies» (R. Lazarus, adapted version of T.A. Kryukova). Statistical analysis was performed with use of computer Statistica 10.0 software program.

Results. After CABG patients with coronary artery disease show a significant reduction of the parameters of the anxious variant of the internal picture of the disease on the basis of TOBOL questionnaire, of the «positive re-evaluation» coping strategy on the basis of evaluation of stress-coping behavior and of the level of «Aim» scale on the basis of evaluation of the level of neurotization using the «Life-Purpose» test.

Conclusion. The results of the study indicate reduction of the level of adaptation to the disease in patients with coronary artery disease after CABG in result of behavioral disorders and difficulties in setting further aims for recovery. To increase postoperative adaptation, the psychocorrection measures may be «targeted» to the coping strategy for «positive re-evaluation» and assistance in setting aims in the postoperative stage of CABG.


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Nowadays ischemic heart disease (IHD) is a leading cause of disability of the working-age population in Russia [1]. The modern and most effective treatment of IHD is surgical treatment. One of the most high-tech method of cardiosurgical treatment of patients with IHD is considered to be coronary artery bypass surgery (CAPS). It is acknowledged to be the most promising kind of surgical intervention in terms of improvement of the quality of life of patients with severe or rapidly progressing from of IHD [2].

INTERHEART research conducted in 52 countries confirmed the suggestion that alongside with smoking, arterial hypertension and diabetes mellitus, an important factor in progress of cardiologic diseases is psychoemotional disorders [3]. A study of risks of development and of unfavorable outcomes of IHD permitted to identify a number of psychological factors that impede full rehabilitation after CABS: disadaptive variants of the internal picture of the disease (IPD), psychoemotional disorders, non-effective coping strategies, etc. [4].

For the prophylaxis of the postoperative risk factors and for further development of methods of psychological assistance to patients with IHD referred for CABS, a complex study of the structure and dynamics of psychological parameters of this category of patients is required.

The aim of the study was to evaluate the dynamics of the parameters of the psychological status of patients with IHD referred for CABS.

Materials and Methods

A psychological examination of 58 male patients of 40 to 74 years of age with stable IHD with planned CABS in conditions of the artificial circulation in Research Institute for Complex Problems of Cardiovascular Diseases was conducted from 2018 to 2019.

Criteria for inclusion: male gender, planned CABS, voluntary informed consent of for participation in the study.

Criteria for exclusion: unstable angina; reduced ejection fraction of the left ventricle (less than 40%); evident disorders in the rhythm and conduction of the heart; recent (less than 28 days ago) myocardial infarction; existence of serious somatic diseases preventing implementation of rehabilitation measures; refusal of the patient from participation in the study.

The study was carried out in accordance with standards of Good Clinical Practice and with principles of the World Medical Association’s Declaration of Helsinki «Ethical conduct of the study with participation of human». All participants signed Informed voluntary consent. The work was conducted in support of complex program of fundamental scientific research of Siberian Branch of the Russian Academy of Sciences. The protocol of the study was approved by Ethic Committee of Research Institute for Complex Problems of Cardiovascular Diseases.

Clinical anamnestic characteristics are given in Table 1.

 

Table 1 Clinical Anamnestic Characteristics of Patients of Preoperative Period of CABS (n=58)

Parameter

Result

Mean age, years, Me [Q25; Q75]

60 (54;65)

Duration of ischemic heart disease, years, Me [Q25; Q75]

1 (1;4)

Duration of arterial hypertension, years, Me [Q25; Q75]

6 (3;9)

Arterial hypertension, n (%)

54 (93)

Stenoses of carotid arteries, n (%)

19 (33)

Ejection fraction of the left ventricle, Me [Q25; Q75]

60.5 (55;64)

Myocardial infarction in history, n (%)

35 (61)

Body mass index, kg/m2, Me [Q25; Q75]

28 (25;31)

Total cholesterol, mmol/l, Me [Q25; Q75]

3.9 (3.4;4.2)

 

 Clinical psychological diagnosis of patients with IHD was conducted by a clinical psychologist with the help of questionnaires on the 2nd-3d day after admission to the hospital and in 7-8 days after CABS. The diagnosis included evaluation of IPD using TOBOL questionnaire (L.I. Vasserman, et al.), evaluation of the level of neurotization of personality using Life-Purpose Orientation test (D.A. Leontieva) and of behavior using Coping Behavior Strategies methodology (R. Lazarus, S. Folkman, adapted version of T.A. Kryukova).

Statistical analysis was conducted using Statistica 10.0 computer software program (Stat Soft Inc., USA). The dynamics of clinical and psychological parameters was evaluated by T-Wilcoxon test. Clinical and psychological parameters were presented I the form of median of 25th and 75th percentiles (Me [Q25; Q75]).

Results and Discussion

Examination of the dynamics of IPD showed a significant reduction of the level of the anxious internal picture of the disease after CABS (Table 2).

Analysis of the dynamics of parameters of coping behavior revealed statistically significant reduction of the level of ‘Positive re-evaluation’ coping strategy (Table 3).

A study of the dynamics of life-purpose orientations in patients with IHD showed a significant reduction of the ‘Aim’ parameter after CABS (Table 4).

Thus, as it is known, preparation to surgical intervention may become a strong stress factor for a patient and may negatively influence his psychological state and further success of medical and rehabilitation measures. In this context, evaluation of the psychological status is an obligatory constituent of the com plex rehabilitation program. Identification of factors that influence formation of neurotic disorders in patients with IHD prior to CABS permits timely correction of psychoemotional disorders that worsen the postoperative course of the disease.

 

Table 2 Dynamics of IPD Parameters in Patients with IHD Referred for Coronary Artery Bypass Surgery

Parameters

Internal Picture of Disease, points, Me [Q25; Q75]

p

before CABS

7-10 days after CABS

Harmonic

33 (26;42)

31 (25;40)

0.1

Ergopathic

29 (26;40)

29 (19;40)

0.2

Anosognostic

24 (16;32)

20 (13;30)

0.2

Sensitive

12 (8;17)

15 (8;21)

0.7

Hypochondriac

7 (4;11)

7 (4;14)

0.6

Ergocentric

5 (4;8)

5 (5;9)

0.1

Anxious

3 (0;8)

0 (0;7)

0.03

Neurasthenic

3 (0;7)

4 (0;11)

0.1

Paranoic

2 (0;4)

2 (0;6)

0.9

Melancholic

0 (0;4)

0 (0;4)

0.2

Dysphoric

0 (0;3)

0 (0;4)

0.2

Apathic

0 (0;3)

0 (0;6)

0.9

 

Table 3 Dynamics of Expression of Models of Coping Strategy in Patients with IHD Referred for Coronary Artery Bypass Surgery

Parameters

Coping Strategies, points, Me [Q25; Q75]

p

before CABS

7-10 days after CABS

Distancing

51 (44;58)

48 (41;58)

0.2

Search for social support

50 (40;57)

46 (40;51)

0.5

Positive re-evaluation

50 (41;55)

45 (38;53)

0.03

Planning of problem salvation

48 (42;56)

45 (42;51)

0.4

Escape-avoidance

46 (38;52)

46 (35;54)

0.07

Confrontation

46 (38;51)

42 (4;11)

0.3

Self-control

45 (39;54)

42 (33;51)

0.2

Taking responsibility

44 (8;17)

47 (40;55)

0.3

 

Table 4 Dynamics of Expression of Life-Purpose Orientation in Patients with IHD Referred for Coronary Artery Bypass Surgery (n=58)

Parameters

Life-Purpose Orientations, points, Me [Q25; Q75]

p

before CABS

7-10 days after CABS

General comprehension of life

154 (135;169)

154 (135;162)

0.4

Aim

38 (31;40)

36 (31;38)

0.02

Process

33 (31;40)

35 (29;37)

0.7

Locus of control - life

32 (28;37)

33 (27;40)

0.6

Result

28 (26;32)

27 (23;32)

0.1

Locus of control - ego

23 (20;25)

23(19;25)

0.1

 

The results of the conducted study of the dynamics of the psychological status parameters of patients with IHD showed alteration of the parameters of IPD, of coping-behavior and life-purpose orientations after conducted CABS.

One of important factors that determines postoperative psychological status of the patient, is his IPD [5]. It is known that high levels of disadaptive anxiodepressive variants of IPD lead to a more frequent and unjustified seeking medical advice as well as to inadequate fulfilment of medical prescriptions [6]. A study of parameters of IPD in patients with IHD after CABS showed a reliable reduction of parameters of the anxious picture of the disease which indicates direct relationship of IPD with expectation of the surgical intervention. Thus, without rendering additional psychological assistance the parameters of anxious IPD may change by themselves after the operation.

A study of behavioral peculiarities of patients with IHD, in particular, of stresscoping behavior, showed reduction of parameters of ‘positive re-evaluation‘. The results of study of this coping strategy in patients with past myocardial infarction showed a positive influence of ‘positive re-evaluation’ on reduction of negative emotions. In patients with past myocardial infarction having low predisposition to using this coping strategy, there may appear both increase in negative emotions or indifferent attitude to the course of the disease and to probable complications which negatively influence prognosis for the recovery [7]. Evaluation of coping behavior showed a significant reduction of ‘positive re-evaluation’ that may lead to additional risks of psychological disadaptation in the postoperative stage of CABS. Thus, formation of positive mindset to recovery using psychotherapeutic methods before and after CABS may be one of ‘targets’ of psychocorrection.

A study of life-purpose orientations showed a significant reduction of the ‘Aim’ parameter after CAPS. It is known that high values on this scale show the ability of the patient to set aims for the future which gives meaning, direction and time-associated prospects to life. Reduction of these parameters indicates difficulties in setting long-term aims which may lead to depressive state [8]. With this, it is known that depression is a significant prognostic factor of repeated hospitalizations and of increased risk of death in the period within 2 to 6 months after CABS [9]. From there, an important ‘target’ of psychological action is assistance in setting aims for further recovery after the operation.

Conclusion

The results of study permitted to make the conclusion about reduction of the level of adaptation in patients with IHD after CABS due to behavioral disorders and difficulties in setting further aims for recovery. The ‘target’ for psychocorrection to increase adaptation of patients with IHD after CABS may be coping strategy of ‘positive revaluation’ and assistance in setting aims in the post-operative period.

About the authors

Anton V. Solodukhin

Research Institute for Complex Problems of Cardiovascular Diseases

Author for correspondence.
Email: mein11@mail.ru
ORCID iD: 0000-0001-8046-5470
SPIN-code: 5487-7469
ResearcherId: H-7252-2016

Russian Federation, Kemerovo

Laboratory Assistant-Researcher of the Neurovascular Pathology Laboratory, Research Institute for Complex Issues of Cardiovascular Diseases

Ol`ga A. Trubnikova

Research Institute for Complex Problems of Cardiovascular Diseases

Email: mein11@mail.ru
ORCID iD: 0000-0001-8260-8033
SPIN-code: 9174-6197
ResearcherId: N-5437-2015

Russian Federation, Kemerovo

MD, PhD, Head of the Neurovascular Pathology Laboratory, Research Institute for Complex Issues of Cardiovascular Diseases

Ol`ga L. Barbarash

Research Institute for Complex Problems of Cardiovascular Diseases

Email: mein11@mail.ru
ORCID iD: 0000-0002-4642-3610
SPIN-code: 5373-7620
ResearcherId: A-4834-2017

Russian Federation, Kemerovo

MD, PhD, Professor, Correspondent Member of RAS, Director, Research Institute for Complex Issues of Cardiovascular Diseases

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