УДК : 613.84:616.89:616.132-089]-06
Aim. To establish the features of the dynamics of TDR in patients with coronary artery disease before and after CABG surgery, depending on age, the presence of the smoking factor and its cessation during the rehabilitation treatment.
Materials and Methods. 122 patients with chronic coronary artery disease aged 40 to 83 years (mean age 62.39±0.65 years) with indications for CABG were examined. Patients were divided into two groups by age: the first (I) group included 45 patients<60 years, and the second group included 77 patients ≥ 60 years. Patients in each age subgroup were divided into subgroups by smoking factor. Subgroups IA (n=28, mean age 55.21±0.91) and IIA (n=18, mean age 65.0±0.77) were formed from patients-smokers; IB (n=17, mean age 55.17±1.26) and IIB (n=59, mean age 67.08±0.61) were from patients who had never smoked. To verify the manifestations of anxiety and depression, we used the screening method of the survey using the hospital scale HADS (The Hospital Anxiety and Depression Scale) before CABG and after 12 months of rehabilitation treatment. Results and Discussion. At the beginning of the study, the mean levels of anxiety (7.77±0.45 (I) and 7.57±0.29 (II)) and depression (7.64±0.47 (I) and 7.42±0.31 (II)) in the age groups did not differ significantly, however, smoking patients of the younger age category had significantly higher levels of anxiety (8.64±0.66 (IA) vs. 6.29±0.58 (IB), p<0.05) and depression (8.44±0.67 (IA) vs. 6.32±0.57 (IB), p<0.05), compared to non-smokers of the same age category. In the same subgroup, a significantly higher proportion of individuals with clinical symptoms of TDR (mostly subclinically expressed) was recorded: for anxiety, 64.29% (IA) versus 47.06% (IB), p<0.05; for depression, 78.57%
(IA) versus 47.06% (IB), p<0.05. At the same time, the absence of symptoms of anxiety and depression was mainly
recorded in non-smoking patients (IB): anxiety - 41.18% (IB), p<0.05, depression - 47.06%, p<0.05 (IB), p<0.05. At
the same time, among smoking patients, symptoms of anxiety were absent 1.6 times less often (25.00% (IA)), depression 3.3 times (14.29% (IA)). After 12 months of rehabilitation treatment after CABG, positive dynamics were observed in all groups: the average levels of anxiety and depression were statistically significantly reduced: the average level of anxiety- by 20.43% to 6.33±0.50 (I) and by 25.97% to 5.83±0.24 points (II); depression - by 43.7% to 4.90±0.53 (I) and 37.82% to 5.06±0.32 (II). The most pronounced decrease in the level of anxiety and depression was found in the IA subgroup - that is, among patients of the younger age group who gave up smoking and did not resume this habit within 12 months. The proportion of patients without symptoms of anxiety increased approximately twice in the subgroup IIA (up to 72.22%) and 3.3 times in the subgroup IA (up to 82.14%), and the proportion of individuals without clinical signs of depression increased among them by 5-6 times: up to 85.71% in IA and up to 83.33% in IIA subgroups. In subgroups of patients who have never smoked (IB, IIB), a positive dynamics of an increase in the proportion of individuals without symptoms of anxiety and depression was
also noted, but it turned out to be less significant.
Conclusions. Compared with non-smokers, among smoking patients with indications for CABG, especially those younger than 60 years, the highest levels of anxiety (p<0.05) and depression (p<0.05) are recorded, and the largest
proportions of individuals with their subclinical and clinically pronounced manifestations (more than 70-80%).
The most significant positive dynamics in terms of reducing the average levels of TDR indicators and the proportion of individuals with their clinical manifestations are recorded in subgroups of patients who have quit smoking and have not smoked during 12 months of rehabilitation treatment after CABG. The smoking factor may exacerbate TDR in patients with coronary artery disease, while smoking cessation is accompanied by a more intensive improvement in their psychological state.