Analysis of the characteristic features of psychosocial adaptation of patients with coronary heart disease to chronic heart failure

Abstract

BACKGROUND: Psychosocial risk factors influence the development and progression of chronic heart failure. Early identification and correction of psychosocial risk factors can reduce their negative impact on the severity of heart failure. AIM: To determine a set of clinical characteristics, socio-demographic indicators, personal and psychological characteristics of patients with coronary heart disease depending on the level of psychosocial adaptation to chronic heart failure. MATERIAL AND METHODS: The study involved 120 patients with coronary heart disease and chronic heart failure. The “Questionnaire for assessing psychosocial adaptation of patients with coronary heart disease to chronic heart failure” developed by the authors was used. Based on the testing results, patients were divided into three groups: adapted, conditionally adapted and maladapted. The first group included 40 patients, the second — 65, and the third — 15. The severity of the clinical course of heart failure, adherence to therapy and the presence of comorbid pathology were assessed. The characteristics of personal response, the severity of neurotic states, a tendency toward type D personality, quality of life, level of social support, and cognitive functions were studied. The socio-demographic characteristics of the patients (age, gender, level of education, position held, level of earnings, nature of alcohol consumption) were analyzed. Statistical and correlation data analysis was performed using the statistical computing environment R 4.2.1. The critical level of significance was considered to be p=0.05. RESULTS: The severity of heart failure decreased (τ=0.38, 95% confidence interval 0.25–0.50, p 0.0001); indicators of left ventricular ejection fraction (ρ=–0.46, 95% confidence interval from –0.59 to –0.30, p 0.0001) and quality of life (ρ=0.63, 95% confidence interval 0.51–0.73, p 0.0001) increased as the level of psychosocial adaptation increased. Adapted and maladapted patients differed in age (p=0.0411), level of education (p=0.0179), position (p=0.0217), personal (p 0.0001) and family (p=0.015) financial well-being, characteristics of personal response, severity of neurotic disorders, as well as the level of social support (p 0.05), adherence to treatment (p=0.0004). Type D personality was registered in 100% of maladapted patients. Adapted patients had higher values of cognitive functions (26.5±4.2 points) and lower comorbidity index scores (5.8±2.7 points) than maladapted patients (23.6±2.3 points, p=0.003; 8.7±3.6 points, p=0.0033). CONCLUSION: Differences in the severity of the clinical course of the disease, socio-demographic characteristics, personal and psychological characteristics of patients with coronary heart disease were found as the level of psychosocial adaptation to heart failure decreased.