Assessment of clinical and social aspects of the course of coronary heart disease after coronary bypass graphing according to the International Classification of Functioning, Disabilities and Health

BACKGROUND: It has been established that the prognosis of ischemic heart disease patients after myocardial revascularization depends on the presence of comorbid pathology, which includes, in addition to cardiovascular and non-cardiac, low physical activity as well as the patient’s social status and environmental barriers. The use of the international classification of functioning in this category of patients makes it possible to assess the severity of the impairment of the structures and functions of the organs and systems involved in the process as well as the role of social, personal and contextual environmental factors necessary for the implementation of a comprehensive rehabilitation program.

AIM: To study structural and functional changes in the cardiovascular system and other organs and systems of the body based on clinical and expert parameters and the International Classification of Functioning, Disabilities and Health, the need for social protection measures, the main directions of complex rehabilitation of patients with coronary heart disease after coronary artery bypass grafting.

MATERIALS AND METHODS: The study included 221 patients with severe coronary artery disease requiring myocardial revascularization. All the patients have been examined after coronary bypass surgery in the Bureau of Medical and Social Expertise in Saint Petersburg and recognized as disabled by the third group. The amount of surgical intervention in the patients was different; in most cases (55%) 3 coronary bypass grafts have been inserted. Comorbidity has been assessed according to the Charltson and Kaplan – Feinstein indices.

RESULTS: High frequency of comorbid pathology has been revealed; the most common are cardiovascular diseases, less common — lung diseases, the diseases of the musculoskeletal system, diabetes mellitus. The value of the Kaplan – Feinstein index was 10.08 ± 0.25; Charlson index — 6.50 ± 0.16. In addition to structural disorders of the cardiovascular system, moderate dysfunctions of the respiratory and digestive systems, and metabolism have been determined. Violations of the functions and structures of the body led to restrictions on the categories of life activity: the ability to self-service in 85.07%, independent movement in 81.90%, labor activity in 100%. Among the domains of the international classification of functioning that characterize activity and participation, problems with paid labor activity (100%), movement, housework, and recreation have been identified.

CONCLUSIONS: The study expands the understanding of the frequency of comorbid pathology of disabled people due to coronary artery disease, its impact on prognosis and the development and implementation of an individual rehabilitation program. The international classification of functioning allows to assess the severity of functional and structural changes, disability as well as to determine the need for social protection measures in patients with coronary artery disease.