I. Vakaliuk, R. Nesterak, V. Sovtus
Ivano-Frankivsk National Medical University
Introduction. Coronary heart disease is the main cause of mortality among diseases of the circulatory system, and the use of myocardial revascularisation contributes to the improvement of the disease course. However, along with the use of high-tech diagnostic and treatment methods, cardio-rehabilitation is an integral part of the process with the search of the new methods for its improvement.
The aim of the study. To characterize the basic principles of curation of patients with acute coronary syndrome in the Carpathian region and to evaluate the effectiveness of cardio-rehabilitation of these patients after myocardial revascularization.
Materials and methods. The peculiarities of the course and treatment of acute coronary syndrome in the period from 2014 to 2018 in the Ivano-Frankivsk region were analyzed. There were 210 patients examined with coronary artery disease with different forms and used methods of treatment, patients with stable ischemic heart disease, who were performed percutaneous coronary intervetion; they were divided into groups depending on the methods of restorative treatment and rehabilitation. In order to improve the quality of rehabilitation of patients the suggestive therapy with musical accompaniment was used. The rehabilitation was performed using the author’s program “Psychological rehabilitation of patients with ischemic heart disease and myocardial infarction by optimization of the internal (inner) state”, which included 5 interactive lessons with the use of the elements of the training. Lessons were performed by a cardiologist and psychologist and they were constructed taking into account the components of the inner picture of health. The clinical-anamnestic data, instrumental, psychometric methods were studied at the beginning of treatment, after 1 month and after 6 months of restorative treatment.
Results. Every year the number of percutaneous coronary interventions in the Precarpathian region increases. The study of the course of stable ischemic heart disease revealed that the lowest rates of depression were in men under 45 years and over 75 years old, the highest in men aged 45-59 years. The use of the program contributed to a significant reduction of the signs of anxiety during 6 months of treatment. Planed stenting with further rehabilitation and rehabilitation under the program contributes to the positive dynamics of hemodynamics with a decrease in left ventricle volume (end systolic volume from 127.50 ± 6.12 to 109.50 ± 76.00 cm3; end diastolic volume from 65.30 ± 3.20 to 54.40 ± 3.00 cm3 (p < 0.05); the improvement in quality of life also depended on the treatment used, on a scale ″Attitude to illness″ in traditional treatment – 60.0 ± 5.0 %, in the group of the suggestive 80.0 ± 4.0 and 93.0 ± 5.0 %, respectively (p < 0.05) were found to reduce depression and anxiety in patients with stable coronary heart disease. Thus, the average anxiety score decreased by 29.7 % from 8.36 ± 0.61 at the beginning of treatment to 5.88 ± 0.47 points after 6 months of curation.
Conclusions. Analyzing the peculiarities of the course and treatment of patients with acute coronary syndrome in the period 2014-2018 in the Carpathian region, it is found that the introduction of modern methods of restoration of coronary blood flow with the use of urgent on the planned stenting can significantly affect the occurrence of cases. There is an increase in the number of percutaneous coronary interventions performed in patients with acute coronary syndrome, and no regularities are noted among the planned interventions. The effectiveness of curation of patients with acute coronary syndrome is mediated by a number of clinical and psychological characteristics, namely the type of blood supply, the chosen method of restoration of the coronary flow, its urgent performance, changes in intracardiac hemodynamics and psycho-emotional state of the patient. Timely restoration of coronary perfusion and effective rehabilitation measures in patients with coronary heart disease provide correction of the clinical course of the disease, reducing the signs of depression and improving the quality of life of patients. Evaluating the effectiveness of cardiorehabilitation, a combination of traditional treatment of suggestive curation and training in the program of “Psychological rehabilitation of patients with coronary heart disease and myocardial infarction by optimizing the internal state” is inserted as appropriate.
- Aronov D, Bubnov M, Krasnytsky W. Patients undergoing myocardial infarction with an elevated ST segment of the electrocardiogram. Cardiology. 2015;55(12):5-11. (Russian)
- Vacalyuk I, Nesterak R, Gasyuk M. Program of psychological rehabilitation of cardiologic patients by optimizing the internal picture of health. Author’s Certificate No. 75681 dated 29.12.2017. (Ukrainian).
- Gasiuk M, Nesterak R. Internal picture of the health of patients with coronary heart disease and myocardial infarction: an empirical study. Scientific Herald of Kherson State the University. 2018;2(2):149-155. (Ukrainian).
- Horbas MI. Ischemic heart disease: epidemiology and statistics. Health of Ukraine [Internet]. 2015 [cited 2015 March 27]. Available from: http://health-ua.com/article/15840-shemchna-hvoroba-sertcya-epdemologya–statistika). (Ukrainian).
- Dyachuk D, Yaschenko Y, Lysenko I. The prevalence of circulatory system diseases among the adult population, which is provided with medical aid at the DNU “NPC PKM” DUS. Bulletin of Biology and Medicine. 2015;2(1):290-294. (Ukrainian).
- Klimenko V, Denisenko I. Topical issues of organization of medical rehabilitation of cardiological patients in modern conditions. Ukraine. The Health of the Nation. 2010;2(14):79-83. (Ukrainian).
- Korchinsky V. Cardio-rehabilitation: the current state and development priorities. Herald of Vinnytsia National Honey University. 2015;19(11):244-247. (Ukrainian).
- Kudrya I, Shevchenko T. Assessment of the course and quality of life in patients with coronary heart disease after stenting coronary arteries. Topical Issues of Modern Medicine. 2014;14(2):19-22. (Ukrainian).
- Lisova O. The internal picture of health. Collection of scientific works NPU Named After MP Drahomanov. 2002;15:69-77. Ukrainian).
- Skopets I, Vezikova N, Marusenko I, Malygin A. Acute coronary syndrome: a comprehensive view of the problem, the value of the inpatient and outpatient stages of treating patients. Archive of Internal Medicine. 2012;3(5):58-64. (Russian).
- Smirnov V, Reznikova T. The basic principles and methods of psychological study of the internal picture of the disease. Methods of psychological diagnosis and correction in the clinic. 1983;38-62. (Russian).
- Sokolov M et al. Registry of percutaneous coronary interventions: a comparative analysis of 2014-2015. Regional reperfusion networks in Ukraine – the dynamics of development. Heart and Blood Vessels. 2016;3:14-34. (Russian)
- Dixhoorna J, Adrian White А. Relaxation therapy for rehabilitation and prevention in ischaemic heart disease. Eur J Cardiovasc Prev Rehabil. 2005;3:193-202.
- Cohen DJ, Van Hout B, Serruys PW, Mohr FW, Macaya C, den Heijer P et al. Quality of life after PCI with drugeluting stents or coronary-artery bypass surgery. N Engl J Med. 2011;364(11):1016-1026.
- Kedhi E, Fabris E, van de Ent M, Buszman P, von Birgelen C, Roolvink V et al. Six months versus 12 months dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction (DAPT-STEMI): randomised, multicentre, non-inferiority trial. BMJ [Internet]. 2018 Oct. [cited 2018 Oct 2]; 363:k3793. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167608/.
- Kwan G, Balady GJ. Cardiac Rehabilitation 2012 Advancing the Field Through Emerging Science. Circulation 2012;125:369-373.
- Wirtz PH, von Känel R. Pshychological stress, inflammation, and coronary heart disease. Curr Cardiol Rep. 2017;19:111.