In a large number of patients aortocoronary shunting often leads to persistent neurotic disorders' development. Taking into account the biological, psychological and social factors contributing to the disease pathogenesis, the authors tend to introduce some methods of active involvement of patients into a rehabilitation-prophylactic process to restore their mental health balance, behavioral standards, communicative habits etc.
According to the definition of the World Health Organization (WHO) "rehabilitation is a comprehensive and coordinated application of medical, social, educational and occupational measures to adapt a sick person to new life and to assist in gaining the best possible physical fitness". With respect to patients with cardiovascular diseases, the significance of comprehensive cardiologic rehabilitation is particularly emphasized. Return to work is by some authors perceived as a marker of rehabilitation efficiency. At the 8th World Rehabilitation Congress held in Dublin in May 2004, Perk (Sweden) reviewed the literature addressing the issue of returning to work. Over the recent seventy years, 460 publications devoted to this topic have been published. They mainly focus on the proportion of persons who return to work after myocardial infarction, percutaneous angioplasty of coronary arteries or implantation of aortic-coronary stents as well as on factors contributing to this success. It has been revealed that rehabilitation is one of numerous factors. Interestingly, socioeconomic and psychological, but not medical, factors play the major role in assuring return to work. There are also other factors which play a role, such as age
Return To Work (RTW) is an important indicator of recovery from coronary artery disease (CAD), associated with social and economical benefits, and improved quality of life. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are effective procedures relieving symptoms and reducing the risk for new events, but psychosocial problems are frequent among these patients. The aim was to determine psychosocial and treatment-related factors associated with RTW among PCI and CABG patients in Northern Norway.
Cross-sectional design based on questionnaire data from CABG and PCI patients 3-15 months following discharge, and from hospital records.
Of the 348 responding patients, 168 were younger than 67 years and working prior to hospitalization. Factors associated with RTW were examined in a logistic regression analysis.
A total of 108 (64%) had RTW within 3-15 months. Four factors made unique significant contributions to the model, including higher education, time since hospital discharge and Internal Locus of Control (LoC) of the Multidimensional Health Locus of Control Scale (MHLC) as positively associated factors, and Powerful Others LoC as a negatively associated factor. Analyses controlled for data on demographics, emergency status, type of treatment, number of days at the hospital, physical exercise, attending a rehabilitation program, mental distress, Type D personality, and for the CABG patients additional data on coronary health.
Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed.
BACKGROUND: Depressive mood after a cardiac event is common with serious consequences for the patient. AIMS: To compare gender in depressive mood during the first year after a cardiac event and to evaluate the effect of participating in a multidimensional secondary prevention program on depressive mood. METHODS: 166 men and 54 women,
The purpose of this study was to determine if health-related quality of life (HRQL) improves after coronary artery bypass graft (CABG) surgery in older women.
The study design was longitudinal observational.
The study took place in a tertiary-care teaching hospital in Hamilton, Ontario, Canada.
Study participants included 34 women 61 years or older who had elective or urgent CABG surgery for the first time. OUTSOME MEASURES: The 2 measures of HRQL were the Medical Outcomes Study Short Form-36 and the Feeling Thermometer (FT). The Short Form-36 is composed of 8 subscales that are summarized into the Physical and the Mental Composite Scores. The FT is a utility measure that rates patients' preferences for different health states.
HRQL of older women was improved after CABG surgery: 7.79 points in the physical composite scores (P = .001), 7.26 in the mental composite scores (P = .008), and 29.77 points in the FT scores (P
In a case-control study 49 consecutive post-coronary artery bypass grafting (CABG) patients (10 f, 39 m) participating in a comprehensive rehabilitation programme were compared with 98 individually matched double control patients, receiving standard care. The rehabilitation programme, starting 6 weeks after surgery, consisted of follow-up at a coronary clinic, repeated health education, and physical training in out-patient groups. During the first year after CABG, fewer study group patients were readmitted to hospital (14% vs 32%, p less than 0.01) and on fewer occasions (1.1 vs 2.9, p less than 0.05). Fewer patients used anxiolytic drugs (0% vs 15%, p less than 0.01). At the one year post-CABG exercise test we found in the study group a tendency to a greater increase in work capacity, as compared with the values obtained at the preoperative exercise test (33 vs 25 W ns). There were no differences in the rates of returning to work (59% vs 64%). In a long-term follow-up study (av. 38 months post-CABG) the patients were asked to fill in a questionnaire evaluating perceived physical work capacity and training habits. The study group patients rated their physical work capacity higher, and more patients had continued with regular physical training (66% vs 46%, p = 0.05). There were fewer patients using anxiolytic drugs (9% vs 30%, p less than 0.01). Although the programme did not influence the return to work we conclude that it improved the quality of life of our patients as it entailed fewer readmissions and reduced the use of anxiolytic medication; in addition it promoted physical fitness and training habits.
The purpose of this study was to monitor changes in health-related quality of life and to identify associated factors among patients having coronary artery bypass grafting and their significant others.
Heart disease and its treatment affects the lives of both patients and their significant others, and the early stage of recovery from surgery causes particular anxiety for both.
In this longitudinal study, three sets of questionnaire data were collected 1, 6 and 12 months after coronary artery bypass grafting surgery from patients and significant others at one university hospital in Finland in 2001-2005. We recruited all patients who had been admitted for elective coronary artery bypass grafting surgery during the period specified. The data consisted of the responses from those patients and significant others who had completed all three questionnaires and for whom patient-significant other pairs existed (n = 163).
Patients' and their significant others' health-related quality of life was at its lowest one month after the operation and improved during follow-up. The change in the mean health-related quality of life score differed between patients and significant others; the improvement in the patients' health-related quality of life was greater than that in the significant others. Neither the background variables used in the study nor social support were associated with change in health-related quality of life.
Further research is needed to identify factors explaining the change in health-related quality of life to develop interventions to support patients and significant others.
To describe the impact of a history of diabetes mellitus on the improvement of symptoms and various aspects of quality of life (QoL) during 5 years after coronary artery bypass grafting (CABG). Patients who underwent CABG between 1988 and 1991 in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. QoL was estimated with three different instruments: Physical Activity Score (PAS), Nottingham Health Profile (NHP) and Psychological General Well-Being (PGWB) index. 876 patients participated in the evaluation, of whom 87 (10%) had a history of diabetes. Symptoms of dyspnea and chest pain improved both in diabetic and non-diabetic patients. Diabetic patients scored worse than non-diabetic patients both prior to and 5 years after CABG, but without any major difference in improvement between the two groups with all three measures of QoL. PAS tended to improve more in non-diabetic than in diabetic patients, whereas improvement in NHP and PGWB was similar regardless of a history of diabetes. Diabetic patients differ from non-diabetic patients having an inferior QoL both prior to and 5 years after CABG. Both diabetic and non-diabetic patients improve in symptoms and QoL after the operation.In some aspects improvement tended to be less marked in the diabetic patients but on the whole improvement was similar compared to non-diabetic patients.
AIM: To describe (1) the improvement in various aspects of quality of life (QoL) and (2) predictors of improvement, during 10 years after coronary artery bypass grafting (CABG). PATIENTS AND METHODS: All patients who underwent CABG in western Sweden between June 1988 and June 1991 without simultaneous valve surgery and with no previous CABG were approached with an inquiry prior to and 5 and 10 years after the operation. QoL was measured with three different instruments: (1) Nottingham health profile (NHP), (2) psychological general well-being index (PGWBI) and (3) physical activity score (PAS). RESULTS: There was a significant improvement in QoL with all three instruments from before to 10 years after the operation. The mean improvements +/-SD were for NHP, - 4.2+/-17.0 (P
The purpose of this study was to describe the life course of coronary artery disease patients from their own perspective at the onset of coronary artery disease and during both the in-patient period and the one-year period of aftercare. Nineteen people selected from a population of 200 patients who had undergone either coronary artery bypass surgery or percutaneous transluminal coronary angioplasty were available for thematic interviews. Interviews were conducted one year after the treatment in the subject's homes. Analyses revealed two distinct types of life course; accepting and progressive, as opposed to non-accepting and regressive. Participants who represented an accepting and progressive life course achieved a better level of rehabilitation than those with a non-accepting and regressive life course. If health care personnel are able to identify the problems related to a non-accepting, regressive life course, they will be better able to support patients' individual life course planning. According to the present findings, a rehabilitation programme is particularly needed for patients with acute onset of coronary artery disease at a relatively early age, disruption of an active working career, financial problems, dissatisfaction with outcome of treatment, family problems and a dismal view of the future. The findings challenge health care personnel to listen to coronary patients' own experiences.