APPLICATION OF “PROGRAM OF CLINICAL-PSYCHOLOGICAL REHABILITATION BY OPTIMIZATION OF THE INTERNAL PICTURE OF HEALTH” IN PATIENTS AFTER ACUTE CORONARY SYNDROME

Aim. To analyze the effectiveness of the “Program of clinical-psychological rehabilitation by optimization of the internal picture of health” of patients after acute coronary syndrome at the stage of rehabilitation. Materials. There were examined 120 patients with ST-segment elevation myocardial infarction, who were di-vided into groups with conservative treatment and thrombolytic therapy followed by coronary artery stenting. Clinical-anamnestic characteristics of patients, laboratory and instrumental data were analyzed, questionnaire survey according to the “Scale of Assessment of the Level of Reactive (Situational) and Personal Anxiety” of Spielberg-Khanin; quality of life according to the Seattle Questionnaire were performed. Traditional rehabilitation measures and rehabilitation with optimization of the internal picture of health were applied according to the “Program of clinical-psychological rehabilitation of cardiac patients by optimization of the internal picture of health”. Results of the study. In the group of patients who were performed thrombolytic therapy, a higher percentage of men aged 45-59 years were found, and in the group of conservative treatment the age of patients was 60-74 years and more than 75 years. Indices of reactive and personality anxiety levels were high at the beginning of the observation, regardless of the used therapeutic method. A month later, the reduction of the reactive anxiety levels was found, however, these changes were more significant in the traditional treatment group with the optimization of internal picture of health (p<0.05). Positive dynamics of the lipid profile was revealed, with a decrease of atherogenic lipoprotein fractions. At the beginning of treatment, the lipid profile indices in both groups did not differ significantly. However, in the course of treatment, they decreased; these changes were observed more pronounced in the group of patients with traditional rehabilitation with optimization of internal picture of health. Quality of life index was low at the beginning of treatment according to all scales of SAQ questionnaire. However, after 6 months of treatment, higher quality of life was reported according to most scales in patients who were performed thrombolytic therapy with coronary arteries' stenting and the combination of traditional treatment with optimization of the internal health picture. The index of attitude to the disease according to the quality of life scale was low in all groups of patients at the beginning of treatment, but after 6 months of treatment with the use of traditional treatment with optimization of IPH a significant increase of this index was determined, at the beginning of treatment it was – 47±5%, and after 6 months 87±4% (p<0.05). Conclusions. Application of the “Program of clinical-psychological rehabilitation by optimization of the inter-nal picture of health” in patients after acute coronary syndrome improves the state of functional recovery of patients, making the clinical course of the rehabilitation period, indices of physical and psychological state better, contributes to the reduction of levels of personal and reactive anxiety and to the correction of dyslipidemia manifestations with the decrease of levels of atherogenic lipoproteins. Traditional rehabilitation with internal picture of health optimization creates the conditions for motivation to change behavioral risk factors, which encourages fuller use of secondary pre-vention tools.