Psychosocial Adaptation Level and Work Participation Rate of Young and Middle-aged Patients with Coronary Heart Disease after PCI

Hongyun ZHENG, Yan ZHAN, Li ZHANG

1. School of Nursing, Hubei University of Medicine, Shiyan 442000, China; 2. Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan 442000, China

Abstract [Objectives] The research aimed to understand the psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease after PCI and their participation situation in work. [Methods] 210 young and middle-aged patients aged 18-59 years with coronary heart disease treated by PCI in a tertiary hospital of Suzhou from July of 2020 to November of 2022 were selected, and general information of patients in three days after operation was registered. Self-report psychosocial adjustment to illness scale (PAIS-SR) was used to investigate the psychosocial adjustment to illness of patients in 1, 3 and 6 months after operation and the participation rate of work. [Results] The psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease after PCI was different in gender, age, education level, marital status, hypertension, diabetes, postoperative cardiac color Doppler ultrasound results (left ventricular ejection fraction) and the number of stents (P<0.05). [Conclusions] The psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease after PCI needs to be improved. The psychosocial adjustment to illness of men is higher than that of women. The older the age is, the lower the psychosocial adjustment to illness is. The psychosocial adjustment to illness of patients with high educational background is higher than those with low educational background, while the psychosocial adjustment to illness of married people is higher than unmarried people. The psychosocial adjustment to illness of patients with hypertension and / or diabetes is lower.

Key words Young and middle-aged, Coronary heart disease, PCI, Psychology

1 Introduction

There is an upward trend in patients with coronary heart disease in China[1]. At present, there are about 11.39 million patients with coronary heart disease[2]. Meanwhile, the young and middle-aged coronary heart disease group also shows an upward trend. The survey in Suzhou during 2009-2013 found that the average annual growth rate of coronary heart disease among residents aged 20 to 49 years was 6.37%[3]. Percutaneous coronary intervention (PCI) is an important treatment for patients with coronary heart disease. To 2017, the total number of PCI cases in Chinese mainland was 753 142[4]. As the economic pillar in the family and the leader in the work, young and middle-aged groups occupy an important position in the society. Their treatment and rehabilitation are always concerned by everyone. After PCI, they should also join social work and family care. This study aimed to understand the psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease in 1, 3 and 6 months after PCI and their work recovery rate after operation.

2 Research objects and methods

2.1 Research objects210 young and middle-aged patients aged 18-59 years with coronary heart disease who underwent PCI in a tertiary hospital of Suzhou from July 2020 to November 2022 were selected, and their average age was (50.49±7.42) years. Among them, there were 170 men and 40 women. Inclusion criteria: (i) patients with coronary heart disease underwent PCI for the first time and stent implantation was successful (TIMI grade 3 blood flow can be achieved and maintained by coronary angiography after operation); (ii) patients who signed informed consent after PCI; (iii) aged between 18-59 years. Exclusion criteria: (i) patients with PCI failure; (ii) patients who underwent revascularization within 3 months after the first PCI; (iii) patients with mental, cognitive, hearing and language disorders who cannot accept the questionnaire survey; (iv) patients suffering from cancer or important organ failure, which seriously affect the quality of life; (v) patients who cannot take medicine regularly and/or receive regular follow-up due to various reasons.

2.2 Research methods

2.2.1Research tools. General information questionnaire: registering general information of patients (gender, age, education level, place of residence, marital status, smoking history, drinking history, payment method); clinical data [hypertension, diabetes, dyslipidemia, number of stents implanted, cardiac color Doppler ultrasound results (left ventricular ejection fraction)]. Self-report psychosocial adjustment to illness scale (PAIS-SR): it was originally developed by Derogatis LR in 1986, and was a scale specially used to evaluate patients’ psychosocial adaptation[5]. In the original version, there were 46 entries and 7 dimensions, Cronbach’s α=0.81, with good construct validity. This scale has multiple language versions. After Chinese adaptation[6]and deleting 2 items (44 items are finally determined), it is re-divided into 7 dimensions (working ability, health care, family relations, sexual ability, communication, entertainment and psychological status). The scale uses 4-level scoring: 0 point, good; 1 point, general; 2 points, poor; 3 points, very poor. Total points is 138, and the higher the score, the more serious the problem of psychosocial adaptation. According to the score, psychosocial adaptation level of patients is divided into three grades: 0-33 points, good; 34-50 points, moderate; 51-138 points, poor. The higher the score, the more the psychosocial adaptation problems, and the lower the psychosocial adaptation level of patients.

2.2.2Data collection. (i) Data in three days after operation: registering general information of patients (gender, age, education level, place of residence, marital status, smoking history, drinking history, payment method); clinical data [hypertension, diabetes, dyslipidemia, number of stents implanted, cardiac color Doppler ultrasound results (left ventricular ejection fraction)]. (ii) Data in 1, 3 and 6 months after operation: the patients who were followed up in 1, 3 and 6 months after operation filled in PAIS-SR, SF-36 scale, whether to smoke, drink and work. (iii) Filling principle: filled in by the patient himself(if it cannot be filled in by the patient for various reasons, it shall be filled in by the researcher after the patient answered by himself).

2.3 Statistical analysisWhen entering data, the double entry method was adopted, and the consistency check was carried out immediately after each data entry. SPSS 22.0 software was used for statistical analysis. Before data analysis, the normality of the data was verified. The counting data conforming to the normal distribution was expressed by rate, composition ratio and percentage. The mean±mean square deviation was used to describe the data, and the skew distribution was described by median and quartile. Statistical analysis used t test (conforming to normal distribution and square deviation) and variance analysis, andP<0.05 showed that difference had statistical significance.

3 Results and analysis

3.1 One-way ANOVA of psychosocial adjustment to illness of postoperative patientsThe PAIS-SR scores of the patients were analyzed by one-way ANOVA. There were statistically significant differences in the psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease in one month after PCI in terms of gender, age, education level, marital status, hypertension, diabetes, postoperative cardiac color Doppler ultrasound results (left ventricular ejection fraction) and the number of stents (P<0.05). There were significant differences in the psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease in 3 months after PCI in terms of gender, age, educational level, marital status, hypertension, diabetes and the number of stents implanted (P<0.05). There were significant differences in the psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease in 6 months after PCI in terms of gender, age, educational level, marital status, hypertension, diabetes and the number of stents (P<0.05). The results were shown in Table 1.

Table 1 One-way ANOVA of psychosocial adjustment to illness of postoperative patients

3.2 PAIS-SR questionnaire score of psychosocial adjustment to illness of postoperative patientsLower PAIS-SR questionnaire score illustrated that the psychosocial adjustment to illness of patients was higher. The female score of PAIS-SR questionnaire was higher than man. The scores of each age stage from low to high were 20-30 years old, 30-40 years old, 40-50 years old and 50-59 years old. The scores of married people, smoking patients and drinking patients were respectively higher than unmarried people, non-smoking patients and non-drinking patients. The scores of educational level from low to high were college degree or above, senior school, junior high school degree, and primary school. The scores of patients with hypertension and diabetes were higher than those without hypertension and diabetes. Work ability dimension score of patients with cardiac color Doppler ultrasound results (left ventricular ejection fraction)≥50 was lower than those whose cardiac color Doppler ultrasound results(left ventricular ejection fraction)<50. The scores of patients with the number of stents from low to high were as follows: patients with 1 stent, patients with 2 stents and patients with 3 stents. The results were shown in Table 2.

Table 2 PAIS-SR questionnaire score of psychosocial adjustment to illness of postoperative patients

4 Discussion

The study on the psychosocial adjustment to illness of young and middle-aged patients with coronary heart disease after PCI showed that the psychosocial adjustment to illness of patients rose from low and medium level in 1 month after PCI to the medium and good level in 6 months after PCI. There were significant differences in gender, age, educational level, marital status, hypertension, diabetes, postoperative cardiac color Doppler ultrasound results (left ventricular ejection fraction) and the number of stents (P<0.05). In terms of the comparison of postoperative quality of life, the life quality of women was lower than that of men[7-8].

In this study, the psychosocial adjustment to illness of men was higher than that of women, which may be related to the fact that the average age of women [(56.05 ± 8.96) years] was higher than that of men [(43.02 ± 9.12) years], and the recovery speed of women was slower than that of men. In terms of age, the older the patients, the lower the psychosocial adjustment to illness. More young PCI patients usually have got single vessel lesions[9]. The younger the patients, the greater the possibility of single vessel lesions. After PCI, the patients can recover quickly. Meanwhile, the older the patient, the more basic diseases may increase accordingly, affecting the recovery of the patient. In the young and middle-aged groups, the older the age (> 45 years old), the heavier the level of self perceived burden[10]. This also reduces the psychosocial adjustment to illness of patients. The higher the educational level, the higher the psychosocial adjustment to illness of patients. The level of educational level affected patients’ cognition of diseases, and cognitive behavior is related to medication compliance[11-12]. Moreover, patients with low educational level are more likely to participate in heavy physical work, which also affects the rehabilitation of patients with coronary heart disease. The psychosocial adjustment to illness of unmarried patients was higher than that of married patients, which may be related to that the age of unmarried patients was lower than that of married patients, and the speed of disease recovery was faster. Patients with hypertension and (or) diabetes had a lower level of psychosocial adjustment to illness. The more stents were placed, the lower the psychosocial adjustment to illness of patients. The LVEF value of patients increased significantly in 3 months after PCI[13-14]. The level of psychosocial adjustment to illness of patients with LVEF <50 in 1 month after PCI was lower than that of patients with LVEF ≥ 50.

After PCI, the psychosocial adjustment to illness of patients was different in gender, age, educational level, marital status, hypertension, diabetes, postoperative cardiac color Doppler ultrasound results (left ventricular ejection fraction) and the number of stents. After PCI, some patients did not participate in work, so it is necessary to improve the psychosocial adjustment to illness of patients, increase the work rate of patients, and make patients integrate into social work as soon as possible.