Studies on sense of coherence, experienced chest pain, psychological well-being, and social support in coronary artery bypass grafting patients. A longitudinal and cross-sectional study

Abstract

Coronary artery bypass grafting (CABG) surgery is a treatment of patients with coronary artery disease. The majority of patients are relieved of their symptoms, although subgroups have persistent/recurrent chest pain. Earlier findings indicate excellent outcome in regard to quality of life (QoL) after CABG. Nevertheless, patients who have poor QoL postoperatively, constitute a large group considering the number of CABG operations performed. Few studies have investigated relationship between chest pain and QoL. Coping capacity, represented here by the sense of coherence concept (SOC), is crucial for QoL. The aims of this study were: to describe coping capacity and psychological well-being before and after CABG; to find preoperative predictors for experience of chest pain one year after CABG; to examine relationships between experience of chest pain, coping capacity, and psychological well-being, and to examine if any relationships were moderated by coping capacity or social support. Two groups were included. Group I (N=111) answered a questionnaire: before the angiography, the day before surgery, and 3, 6, and 12 months postoperatively. Group II (N=102) answered once, 3 years postoperatively. The questionnaire included parts of the Seattle angina questionnaire, one question concerning experience of chest pain, the SOC scale, emotional state (4 questions regarding loneliness, depressed mood, stress, anxiety), the Psychological general well-being index, a global QoL question, and the Multidimensional scale of perceived social support. Medical data were obtained from the medical records.The SOC changed more than + 10% from before to one year after surgery in 41 per cent of the patients, implying that SOC is not a stable construct in adults. High or increased SOC was positively related to less experience of loneliness, depressed mood, stress, anxiety, and to less experience of chest pain at one year. Chest pain was experienced in the first postoperative year by 34 per cent of the patients and by 51 per cent at three years. Independent predictors at one year were moderate/low SOC, ejection fraction <50%, body mass index >25, and moderate/high mood depression. Experience of chest pain was related to lower SOC, emotional state, and psychological well-being index scores. This relation was moderated by high SOC and high social support scores in somewhat different ways. At one year the effect of SOC was unclear while no effect was found of social support. At three years SOC had a positive effect. Among patients without chest pain, at one year both SOC and social support had a positive effect on emotional state and at three years social support had a positive effect in some of the psychological well-being index variables. In conclusion, psychological well-being after CABG is not only dependent on freedom from chest pain. The patient's coping capacity is of great importance for a successful outcome.