THE IMPACT OF AMBULATORY CARDIAC REHABILITATION ON DEPRESSION IN PATIENTS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION

Uvod: U liječenju pacijenata sa kardiovaskularnim bolestima, kardiološka rehabilitacija (KR) se pokazala jako učinkovitim pristupom, osobito u smanjenju komplikacija kardioloških pacijenata. Značajne komponente kardiološke rehabilitacije uključuju smanjenje simptoma i poboljšanje u funkcionalnoj sposobnosti i općem zdravlju odnosno kvalitete života povezane sa zdravljem. Široki raspon pacijentata koji pristupaju različitim intervencijama (npr. perkutana koronarna intervencija (PCI), zamjena srčanih zalistaka i sl.) su indicirani za primjenu KR programa. PCI je invazivna intervencija koja se primjenjuje kod stanja opasnih po život i kao takva predstavlja stresnu intervenciju. Budući da su bolesnici svjesni prirode njihovog stanja, mnogi srčani bolesnici podvrgnuti PCI iskuse psihološku uznemirenost i negativne emocije. Među osobama oboljelih od koronarne bolesti srca (KBS), negativna psihološka stanja su često prisutna, konstantna i povezana s lošim kliničkim ishodima. Psihološki faktori, a među njima i depresija, povezani su sa razvojem, manifestacijom i progresijom KBS-a. Depresija i depresivni sindromi ograničavaju poboljšanje ishoda osobito kvalitetu života, psihološko zdravlje i fizički status pacijenta, te su značajan faktor u povećanju smrtnosti i morbiditeta. Da bi se odgovarajuća intervencija mogla primijeniti, potrebno ih je što ranije otkriti i pravovremeno liječiti. Cilja rada: ispitati utjecaj ambulantne kardiološke rehabilitacije kod pacijenta podvrgnutih perkutanoj koronarnoj intervenciji i s dijagnosticiranom koronarnom bolesti srca na prisustvo simptoma depresije i na zdravstveni status odnosno subjektivnu procjenu kvalitete života i zdravlja tijekom 5-to tjednog rehabilitacijskog programa. Metode: u prospektivnoj kohortnoj studiji, uključeno je 50 muških ispitanika u dobi iznad 30. godine života koji su bili podvrgnuti perkutanoj koronarnoj intervenciji od sprnja do listopada 2016.godine. ispitanici su podijeljeni u dvije jednake skupine: pokusnu skupinu su činili ispitanici kojima je uspješno provedena PCI-a, te nakon otpusta iz bolnice uzimaju optimalnu medikamentoznu terapiju uz organiziranu ambulantnu kardiološku rehabilitaciju, dok je skupina koja je nakon uspješno provedene PCI, po izlasku iz bolnice uzimala optimalnu medikamentoznu terapiju bez ambulantne kardiološke rehabilitacije činila kontrolnu skupinu. Na početku, nakon provedene PCI, te nakon 5 tjedana, provedeno je anketiranje putem mjernih instrumenata. Depresija je procijenjena putem Beckovog inventara depresije (BDI-II), dok se za procjenu subjektivne kvalitete živote koristio SF-36 upitnik. Rezultati: 25 muških osoba je sudjelovalo u pokusnoj (PCI+Rehab) skupini, te 25 u kontrolnoj (PCI-Rehab) skupini. Nakon 5 tjedana, rehabilitacijski program je doveo do statističkih promjena u sistoličkom i dijastoličkom krvnom tlaku, te hiperlipidemiji i pušenju (p vrijednost ˂ 0,05). U skupini koja je provodila rehabilitacijski program došlo je do statistički značajnih promjena u ukupnom rezultatu BDI-II i njegovim pojedinim sastavnicama (p vrijednost ˂ 0,05) te u SF-36 upitniku (fizičko funkcioniranje, opće zdravlje i vitalnost i energija; p vrijendost ˂ 0,05). Zaključak: ambulantna kardiološka rehabilitacija mže biti učinkovita u smanjenju simptoma depresije i poboljšanju kvalitete života povezane sa zdravljem.Background: When treating patients with cardiovascular system diseases, cardiac rehabilitiation appears to be a very efficient method of treatment, especially when it comes to reducing the complications such patients have. Important components of cardiac rehabilitation include reducing the symptoms of the disease and improving both functional ability and health in general, or in other words, improving the quality of life related to health. Wide range of patients who undergo various interventions (like percutaneous coronary intervention – PCI, heart valves’ replacement and others) are indicated for CR programme. PCI is an invasive intervention which is applied in life-threatening situations and states, and is very stressful. The patients being conscious of their health status (and many of them are cardiological patients who undergo PCI intervention), experience anxiety and negative emotions. Negative psychological emotions and states connected to them are common, constant and connected to bad clinical results among the patients suffering from coronary heart disease. Psychological factors (as well as depression among them) are connected to the development, manifestation and progression of the coronary heart disease. Depression syndromes limit the improvement of the results. They especially influence the quality of life, psychological health and physical state of the patient and as such they represent an important factor in the increase of the mortality and the morbidity. In order to apply the suitable treatment, it is necessary to discover and treat those syndromes as early as possible. Objective: to examine the influence of the ambulatory cardiac rehabilitation on the existence of the symptoms of the depression as well as on the health status (subjective estimate of the quality of life and health during five weeks long programme) with patients who undergo percutaneous coronary intervention and are diagnosed with coronary heart disease. Methods: 50 male examinees older than 30 years were included in prospective cohort study. They all underwent percutaneous coronary intervention in period from June to October 2016. The examinees were divided into two equal groups - an experimental group with patients with successful PCI, and who, after leaving the hospital took optimal therapy together with organized ambulatory cardiac rehabilitation. The other group – the control group, was made of those patients who also underwent successful PCI, and who after leaving hospital also took optimal therapy, but without organized ambulatory cardiac rehabilitation. The research was made using measuring instruments at the beginning, after the PCI and after five weeks. The depression was studied with Beck’s depression inventory, while for the estimation of the subjective quality of life, SF-36 questionnaire was used. Results: 25 males were part of an experimental group (PCI+Rehab.), and 25 were part of control group (PCI-Rehab). After five weeks, the rehabilitation programme made changes in systolic and diastolic blood pressure, as well as in hyperlipidemia and smoking (p ˂ 0.05). In the group who underwent rehabilitation programme, there were some statistically important changes in total result of BDI-II and its elements (p ˂ 0.05), as well as in SF-questionnaire (physical functioning, health in general, vitality and energy, p ˂ 0.05). Conclusion: ambulatory cardiac rehabilitation can be efficient in decreasing the symptoms of depression as well as in improving the quality of life related to health. Key words: coronary heart disease, cardiac rehabilitation, depression, percutaneous cardiac intervention