Social and Psychological Factors in Predicting the Effectiveness of Rehabilitation in Patients with Coronary Heart Disease After Coronary Artery Bypass Grafting

Relevance. Cardiovascular diseases predominate in terms of both prevalence and mortality, with coronary artery disease (CAD) playing a central role in overall mortality rates. The relevance of identifying prognostically significant factors for the effectiveness of rehabilitation in patients with CAD is determined by the high prevalence, mortality, and disability associated with the disease; the necessity of ensuring effective control of risk factors during the outpatient rehabilitation stage; and the substantial role of psychological characteristics in disease prognosis.
Objective. To identify social and psychological factors relevant for predicting the effectiveness of rehabilitation in patients with CAD three months after coronary artery bypass grafting (CABG).
Methodology. 254 patients with coronary artery disease who underwent coronary artery bypass grafting were examined. Patients were monitored at the stage of inpatient treatment before and after surgery, as well as at the outpatient stage, 3 months after surgery. The clinical-psychological approach and the following psychodiagnostic methods were used: the Trail-Making Test (TMT), Luria´s Memory Words test, Integrative Anxiety Test, Asthenic State Scale modified by L.D. Malkova and T.G. Chertova, the Symptom Checklist-90-Revised (SCL-90-R), The Ways of Coping Questionnaire (WCQ) by Lazarus and Folkman, 36-Item Short Form Survey (SF-36), and the Big Five Personality Test.
Results and Discussion: A factor analysis of the obtained data was performed. 3 groups of factors were obtained: 1) factors based on sociodemographic data from a structured interview: “Social success” , “Loneliness” , “Stability”; 2) factors based on psychological information from a structured interview: “ Anosognosia and a negative attitude towards treatment against the background of adaptation disorder in the family sphere” , “Depression” , “The importance of getting rid of pain and physical discomfort” , “Psychotraumatic situations” , “Negative attitude towards psychodiagnostics” and egocentric response to illness”; 3) factors according to psychodiagnostic methods: “Psychopathological manifestations and decreased memory and attention” , “Anxious-phobic manifestations” , “Orientation towards coping with difficulties” , “Reduced quality of life and unsatisfactory somatic condition” , “Neurotic manifestations of an anxious-suspicious type” , “Asthenic manifestations against the background of aggressive tendencies” . Factors in predicting the effectiveness of rehabilitation were identified: “Social success” and –with negative values – “Stability” , “Significance of getting rid of pain and physical discomfort” , “Psychotraumatic situations” . Psychological factors: prognostic factors with a negative value were noted – “The importance of getting rid of pain and physical discomfort” and “Psychotraumatic situations” . It is advisable to take into account the results obtained in the process of psychological rehabilitation.
Conclusion. Prognostic factors for the effectiveness of rehabilitation after CABG were identified. Notably, no prognostic value was found for factors derived from psychometric assessment data. Prognostically significant variables were limited to those based on structured interview data collected at the preoperative stage. Among social factors, “Social Success” had a positive predictive value, whereas “Stability” had a negative one. Among psychological factors, negative prognostic significance was observed for “Significance of relief from pain and physical discomfort” and “Psychotraumatic situations”. These findings should be taken into account in the course of psychological rehabilitation.

1. Arsakhanova G.A. Vliyanie khronicheskogo stressa na razvitie ateroskleroza i ishemicheskoi bolezni serdtsa [Impact of chronic stress on the development of atherosclerosis and coronary heart disease]. Vestnik meditsinskogo instituta [Bulletin of the Medical Institute]. 2024; (1(25)): 15–23. URL: https://www.elibrary.ru/item.asp?id=67947259. DOI: 10.36684/med-2024-25-1-15-23 (In Russ.)

2. Boitsov S.A., Pogosova N.V., Ansheles A.A. [et al.]. Kardiovaskulyarnaya profilaktika 2022. Rossiiskie natsional’nye rekomendatsii [Cardiovascular prevention 2022. Russian national guidelines]. Rossiiskii kardiologicheskii zhurnal [Russian Journal of Cardiology]. 2023; 28(5): 119–249. URL: https://www.elibrary.ru/item.asp?id=53969228. DOI: 10.15829/1560-4071-2023-5452 (In Russ.)

3. Bunin V.A., Lin’kova N.S., Kozhevnikova E.O. [et al.]. Ishemicheskaya bolezn’ serdtsa i infarkt miokarda: ot patogeneza k molekulyarnym markeram diagnostiki [Coronary heart disease and myocardial infarction: from the pathogenesisto molecular markers of diagnostics]. Uspekhi fiziologicheskikh nauk [Advances in Physical Sciences]. 2020; 51(1): 33–45. URL: https://elibrary.ru/item.asp?id=42258126. DOI: 10.31857/S030117982001004X (In Russ.)

4. Velikanov А.А. Issledovanie dinamiki psikhologicheskikh faktorov u bol’nykh ishemicheskoi bolezn’yu serdtsa posle koronarnogo shuntirovaniya [Study of the dynamics of psychological factors in patients with coronary heart disease after coronary artery bypass surgery]. Vestnik psikhoterapii [Bulletin of Psychotherapy]. 2024; (90): 37-48. URL: https://www.elibrary.ru/item.asp?id=67965582. DOI: 10.25016/2782-652X-2024-0-90-37-48 (In Russ.)

5. Drapkina O.M., Fedin A.I., Dorofeeva O.A. [et al.]. Vliyanie psikhosotsial’nykh faktorov riska na techenie i prognoz serdechno-sosudistykh zabolevanii [Influence of psychosocial risk factors on the course and prognosis of cardiovascular diseases]. Kardiovaskulyarnaya terapiya i profilaktika [Cardiovascular Therapy and Prevention]. 2022; 21(5): 64–70. URL: https://elibrary.ru/item.asp?id=48572481. DOI: 10.15829/1728-8800-2022-3280 (In Russ.)

6. Drapkina O.M., Kontsevaya A.V., Kalinina A.M. [et al.]. Profilaktika khronicheskikh neinfektsionnykh zabolevanii v Rossiiskoi Federatsii. Natsional’noe rukovodstvo 2022 [2022 prevention of chronic non-communicable diseases in of the russian federation. National guidelines]. Kardiovaskulyarnaya terapiya i profilaktika [Cardiovascular Therapy and Prevention]. 2022; 21(4): 5–232. URL: https://elibrary.ru/item.asp?id=48397291. DOI: 10.15829/1728-8800-2022-3235 (In Russ.)

7. Isakov V.A., Kholkina A.A., Timofeev E.V. Priverzhennost’ lecheniyu komorbidnykh patsientov terapevticheskogo profilya [Adherence to treatment of comorbid therapeutic patients]. Dnevnik kazanskoi meditsinskoi shkoly [Diary of the Kazan medical school]. 2022; (1(35)): 13–20. URL: https://www.elibrary.ru/item.asp?id=50419186 (In Russ.)

8. Kanorskii S.G. Ishemicheskaya bolezn’ serdtsa s vysokim riskom oslozhnenii: kak identifitsirovat’ takikh patsientov i vybirat’ taktiku vedeniya? [Coronary artery disease with a high risk of complications: how to identify such patients and choose management tactics?]. Ratsional’naya farmakoterapiya v kardiologii [Rational Pharmacotherapy in Cardiology]. 2020; 16(3): 465–473. DOI: 10.20996/1819-6446-2020-06-04 (In Russ.)

9. Pogonchenkova I. Vazhnoe uslovie effektivnoi kardioreabilitatsii – rannee nachalo [An important condition for effective cardiac rehabilitation is early initiation]. Moskovskaya meditsina [Moscow Medicine]. 2020; (3(37)): 34–37. URL: https://elibrary.ru/item.asp?id=44047694 (In Russ.)

10. Sviderskaya L.N., Tarasova O.M. Produktivnoe vliyanie motivatsii na zdorov’e populyatsii [Productive influence of motivation on population health]. Zhivaya psikhologiya [Living Psychology]. 2022; 9(5(37)): 19–29. URL: https://elibrary.ru/item.asp?id=50379170. DOI: 10.58551/24136522_2022_9_5_19 (In Russ.)

11. Shchelkova O.Yu., Yakovleva M.V., Eremina D.A. [et al.]. O razrabotke sistemnoi (biopsikhosotsial’noi) modeli prognoza pri serdechno-sosudistykh zabolevaniyakh. Chast’ 2 [On the development of a systemic (biopsychosocial) prediction model for cardiovascular disease. Part II]. Obozrenie psikhiatrii i meditsinskoi psikhologii imeni V.M. Bekhtereva. [V.M. Bekhterev review of psychiatry and medical psychology]. 2023; 57(3): 70–79. URL: https://elibrary.ru/item.asp?id=54681146. DOI: 10.31363/2313-7053-2023-732 (In Russ.)

12. Yakovleva M.V. Priverzhennost’ lecheniyu patsientov, perenesshikh operatsiyu koronarnogo shuntirovaniya, v kontekste ikh psikhosotsial’nykh kharakteristik [Patients’ treatment adherence after coronary bypass surgery in terms of their psychosocial characteristics]. Gertsenovskie chteniya: psikhologicheskie issledovaniya v obrazovanii [Herzen university conference on psychology in education]. 2020; (3): 274–280. URL: https://elibrary.ru/item.asp?id=44271289. DOI: 10.33910/herzenpsyconf-2020-3-74 (In Russ.)