Байкальский медицинский журнал (Sep 2023)
ANALYSIS OF FACTORS ASSOCIATED WITH DETERMINATION IN QUALITY OF LIFE AND EMOTIONAL STATE AFTER SURGERY FOR CORRECTION OF ACQUIRED HEART DISEASES
Abstract
Introduction. The assessment of factors associated with the deterioration of the quality of life (QOL) and emotional state after heart surgery suggests the possibility of their timely elimination and, as a result, a faster return to working capacity and socialization of a patient with acquired heart disease.Target. Identification of factors affecting the deterioration of QoL and emotional state of patients undergoing surgical correction of acquired heart valve defects in the postoperative period.Materials and methods. The study included 103 patients (median age 60.0 years [51.0; 66.0]) from November 2020 to October 2022 who underwent surgical correction of mitral valve disease or in combination with correction of aortic valve disease and /or tricuspid valves. To assess the level of QOL, patients filled out the questionnaire "Shot Form-36 health status survey" (SF-36), to assess the emotional state of the Hospital Anxiety and Depression Scale (HADS) before surgical treatment, on the 7th, 30th day, a year later after the intervention.Results. According to regression analysis, the presence of preoperative atrial fibrillation (AF) was associated with a decrease in the physical component of health according to the SF-36 questionnaire by B-factor = -6.39; p=0.002 before surgery, and B-factor = -10.92; p=0.03 one week after the operation, as well as with a decrease in the mental health component on the 30th day (B-coefficient = -12.66; p=0.006). With an increase in age by 1 unit, the initial level of the physical component of health decreased by B-coefficient = -0.21 (p=0.014). There was an association of males with levels of anxiety (B-value = 3.58; p=0.002) and depression (B-value = 3.04; p=0.002) assessed before and one week after surgery: B-value = 2.34; p=0.03 and B-factor=2.47; p=0.02, respectively, as well as with a higher level of anxiety after a month (B-factor = 2.79; p=0.03). Patients were divided into groups with the presence (group 1) or absence (group 2) of pulmonary hypertension (PH) before surgery according to echocardiography. On the 7th day after the operation, group 1 noted an improvement in mental health (MH; p=0.03), regardless of the increase in the intensity of the pain syndrome (BP; p=0.005). Patients without PH noted a worsening of QoL in terms of self-service and freedom of movement (PF, p=0.04), because of the pain syndrome they considered their QoL to be lower compared to preoperative (BP; p=0.03). On the 7th day in the group without PH, the median level of anxiety decreased by 3 points, in the group with PH only by 1.5 points (p=0.04). The level of depression by the 30th day decreased to 1 point in both groups, remaining stable throughout the year. A month later, the PH group noted an increase in physical capabilities (PF; p=0.03), an increase in overall health (GH; p=0.003), an increase in physical (p<0.0001) and mental (p=0.006) components of QoL , and patients without PH indicated a limitation in the performance of work duties (RP, p=0.047). During the year after the operation, the PH group noted a decrease in pain intensity (BP, p=0.003), an improvement in the emotional state (RE, p=0.04), an increase in the possibility of self-care and free movement (PF, p=0.00008), work responsibilities (RP, p=0.001), which increased overall health (GH, p=0.002), vitality (VT, p=0.0002) and increased social contacts (SF, p=0.001). The quality of life of patients from the group without PH improved only on three points with less significant dynamics: physical functioning (PF, p=0.03), pain intensity (BP, p=0.01) and vital activity (VT, p=0.04 ).Conclusion. The factors influencing the deterioration of QoL and emotional state after surgical correction of PPS are: the presence of preoperative AF, male gender. And the presence of PH before defect correction is associated with better QoL and emotional status after the intervention compared to patients without PH, which may be due to a more severe condition before surgery in people with PH.
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