Rehabilitation of cardiosurgical patients in Russia: medical, social, psychological and legal aspects
Averin E. E., Lopatin Yu. M., Delaru V. V.
Keywords: restorative medicine, cardiac surgery, quality of life, coronary bypass surgery, rehabilitation, interview, anxiety
Relevance. Active development of the Russian cardiac surgery sets requirements for the restructuring and intensifying of rehabilitation after heart surgeries. Objective. Study of the current state of rehabilitation of patients after heart surgeries with the assessment of medical, social, psychological, and legal aspects. Materials and methods. The study included interviews of 37 experts, 320 doctors from treatment facilities of city medical infrastructure, as well as results of the clinical study of 241 patients (132 patients who underwent direct myocardium revascularization and 109 patients who underwent surgeries concerning acquired heart valvular diseases). Results. There is no uniform system of the rehabilitation of patients after cardiac surgeries in Russia. There is an independent rehabilitation system in each region. Heart surgical interventions improved somatic status and quality of life of the patients. However, the results could be more significant, if all patients could receive sanatorium care after cardiac surgeries. According to the law, only employed citizens can receive such after-care at the expense of budgetary means, i.e. social inequality of employed and unemployed citizens is legislated. According to therapists and cardiologists of city medical infrastructure, the most significant difficulties in rehabilitation of patients after cardiac surgeries are complications / impossibility of sanatorium treatment in 19.3 % of cases, insufficient knowledge of rehabilitation process (14.8 %), a lack of knowledge of rehabilitation cardiological patients (13.4 %), frequent neurotization or psychopathisation of such patients (13.4 %), problematic organization of treatment in rehabilitation divisions of craniological centers (12.9 %). Average amount of drugs taken by a patient after coronary bypass surgery was equal to 5.1, and after valve replacement – 4.6. Conservative treatment both before and after cardio surgical interventions should be carried out strictly according to the modern recommendations. However, 75.8 % patients before heart surgery and 34.1 % patients within two years after surgery did not receive required conservative treatment. Generics prevailed among the administered medicinal products. As a result, 78.8 % patients before surgery and 34.1 % CHD patients 2 years after surgery did not reached the target values of low-density lipoproteins and heart rate, which demonstrate the efficacy of relative drug therapy, which improves the prognosis.
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Averin E. E., Lopatin Yu. M., Delaru V. V. Rehabilitation of cardiosurgical patients in Russia: medical, social, psychological and legal aspects. Russian Heart Failure Journal. 2012;13(1):40-45