Psychosocial adaptation to chronic heart failure in patients with coronary heart disease

Cover Page
Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Aim. To assess the effects of acquired social status, neurotic conditions, type D personality, cognitive functions, quality of life and adherence to treatment on psychosocial adaptation of patients with coronary heart disease (IHD) to chronic heart failure (CHF), depending on the severity of decompensation.

Methods. 87 patients with coronary artery disease and chronic heart failure aged between 55 and 72 years were ­examined. All patients were divided into two groups depending on the functional class of chronic heart failure [New York Heart Association (NYHA) class I–IV]. The first group included 41 patients with NYHA functio­nal class I–II, the second group — 46 patients with NYHA functional class III–IV. For a comprehensive study of the psychosocial adaptation of patients, a set of standardized questionnaires was used: the abridged variant of the Minnesota Multiphasic Personality Inventory (SMOL), a clinical questionnaire for identifying and assessing neurotic condition, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 36-Item Short Form Health Survey Questionnaire (SF-36), the Mini Mental State Examination (MMSE), 14-question test “Type D Scale-14” (DS14), Morisky–Green test, the short version of the AUDIT questionnaire (AUDIT-C). We collected data on the patient's social status: gender, education, income level. The results obtained were analyzed.

Results. Based on the SMOL personality profiles, patients of the second group were classified as neurotic — an increase was noted in three neurotic scales: hypochondria (U=541; p=0.030), hysteria (U=579; p=0.048), and autism/schizoid (U=577.5; p=0.047) compared with patients of the first group. According to the results of the clinical questionnaire for the identification and assessment of neurotic condition, the greatest differences were found between patients of first and second groups on the scale of autonomic disorders (U=571; p=0.039) and neurotic depression (U=576; p=0.046). Comparing the groups according to the MLHFQ score, quality of life in patients of the second group was markedly reduced (U=447.5; p <0.001). According to the SF-36 questionnaire, a decrease in the quality of life was also found in patients of the second group on the scale “Physical functioning” (U=554; p=0.032) and “Physical component of health” (U=573.5; p=0.044). The cognitive status in patients of the second group was significantly decreased compared with the first group (U=427; p <0.001). No significant differences were found in adherence to treatment between the two groups (U=757; p=0.666). Also, there were no patients with type D perso­nality on both subscales (U=717.5; p=0.483, U=784; p=0.933) and according to the AUDIT-C scores, there are no significant differences between men (U=681.5; p=0.257) and women (U=728.5; p=0.425) in both groups of patients.

Conclusion. Signs of social maladjustment in patients with more severe NYHA functional class of the disease are expressed by significantly more pronounced social isolation (autism), a tendency to avoid communicating with ­others, isolation on their own problems and hypochondriacal attention to the somatic manifestations of chronic heart failure; probably, the main reason that reduces the level of social adaptation is a high score in neuroticism, which leads to a functional decrease in cognitive abilities and a significant deterioration in quality of life.

Full Text

Restricted Access

About the authors

A G Zhidyaevskij

Kazan State Medical University

Author for correspondence.

Russian Federation, Kazan, Russia

G S Galyautdinov

Kazan State Medical University


Russian Federation, Kazan, Russia

V D Mendelevich

Kazan State Medical University


Russian Federation, Kazan, Russia

A G Gataullina

Kazan State Medical University


Russian Federation, Kazan, Russia

A O Kuzmenko

Kazan State Medical University


Russian Federation, Kazan, Russia


  1. Belenkov Ju.N., Mareev V.Ju. Cardiovascular continuum. Russian Heart Failure Journal. 2002; 3 (1): 7–11. (In Russ.)
  2. Fomin I.V. Chronic heart failure in Russian Federation: what do we know and what to do. Russian Journal of Cardiology. 2016; (8): 7–13. (In Russ.) doi: 10.15829/1560-4071-2016-8-7-13.
  3. Pogosova N.V., Boytsov S.A., Oganov R.G., Yufereva Yu.M., Kostyuk G.P., Kursakov A.A., Ausheva A.K., Vygodin V.A. Clinical-epidemiological program of studying psychosocial risk factors in cardiological practice in patients with arterial hypertension and ischemic heart disease: First results of a multicenter study in Russia. Kardiologiia. 2018; 58 (9): 47–58. (In Russ.) doi: 10.18087/cardio.2018.9.10171.
  4. De Miranda Azevedo R., Roest A.M., Hoen P.W., de Jonge P. Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: A meta-analysis. Psychol. Med. 2014; 44 (13): 2689–2703. doi: 10.1017/S0033291714000063.
  5. Vale S. Psychosocial stress and cardiovascular di­seases. Postgrad Med. J. 2005; 81: 429–435. doi: 10.1136/pgmj.2004.028977.
  6. Consoli S.M. Stress and the cardiovascular system. Encephale. 1993; 19 (1): 163–170. PMID: 8281897.
  7. Allison T.G., Williams D.E., Miller T.D., Patten C.A., Bailey K.R., Squires R.W., Gau G.T. Medical and economic costs of psychologic distress in patients with coronary artery disease. Mayo Clin. Proc. 1995; 70 (8): 734–742. doi: 10.4065/70.8.734.
  8. Gurov V.A., Medvedev V.E. Anxiety disorders in gene­ral medical practice: aspects of clinic and therapy. ­Arkhiv vnutrenney meditsiny. 2011; (2): 15–19. (In Russ.) doi: 10.20514/2226-6704-2011-0-2-15-19.
  9. Pase М.Р., Beiser A., Enserro D., Xanthakis V., Aparicio H., Satizabal C.L., Himali J.J., Kase C.S., Vasan R.S., DeCarli C., Seshadri S. Affiliations expand. Association of ideal cardiovascular health with vascular brain injury and incident dementia. Stroke. 2016; 47 (5): 1201–1206. doi: 10.1161/STROKEAHA.115.012608.
  10. Lowe G.D., Lee A.J., Rumley A. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br. J. Haematol. 1997; 96 (1): 168–73. doi: 10.1046/j.1365-2141.1997.8532481.x.
  11. Shulman K.I., Gold D.P., Cohen C.A., Zucchero C.A. Clock-drawing and dementia in the community: a longitudinal study. Int. J. Geriatr. Psychiatry. 1993; 8: 487–496. doi: 10.1002/gps.930080606.
  12. Vologdina I.V., Simanenkov V.I., Poroshina E.G., Minko B.A. Quality of life and adherence in patients with heart failure, cognitive and affective impairment. Herald of North-Western State Medical University named after I.I. Mechnikov. 2016; 8 (1): 45–49. (In Russ.)
  13. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A., Gendlin G.E., Glezer M.G., Gautier S.V., Dovzhenko T.V., Kobalava Z.D., Koziolova N.A., Koroteev A.V., Mareev Yu.V., Ovchinnikov A.G., Perepech N.B., Tarlovskaya E.I., Chesnikova A.I., Shevchenko A.O., Arutyunov G.P., Belenkov Yu.N., Galyavich A.S., Gilya­revsky S.R., Drapkina O.M., Duplyakov D.V., Lopatin Yu.M., Sitnikova M.Yu., Skibitsky V.V., Shlyakhto E.V. Russian Heart Failure Society, Russian Society of Cardio­logy. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018; 58 (6S): 8–158. (In Russ.) doi: 10.18087/cardio.2475.
  14. Mastenbroek M.H., Versteeg H., Zijlstra W.P., Meine M., Spertus J.A., Pedersen S.S. Disease-­specific health status as a predictor of mortality in patients with heart failure: A systematic literature review and meta-ana­lysis of prospective cohort studies. Eur. J. Heart Fail. 2014; 16 (4): 384–393. doi: 10.1002/ejhf.55.
  15. Oganov R.G., Deni­sov I.N., Simanenkov V.I., Bakulin I.G., Bakulina N.V., Boldueva S.A., Barbarash O.N., Garganeeva N.P., Doshchitsin V.L., Drapkina O.M., Dudinskaya E.N., Kotovs­kaya Yu.V., Lila A.M., Mamedov M.N., Mardanov B.U., Miller O.N., Petrova M.M., Pozdnyakov Yu.M., Runikhi­na N.K., Saiganov S.A., Tarasov A.V., Tkacheva O.N., Urinsky A.M., Shalnova S.A. Comorbidities in practice. Clinical guidelines. Kardiovaskulyarnaya terapiya i profilaktika. 2017; 16 (6): 5–56. (In Russ.) doi: 10.15829/1728-8800-2017-6-5-56.
  16. Shkaratan O.I. Sotsio­logiya neravenstva. Teoriya i real'nost'. (Sociology of ine­quality. Theory and reality.) M.: Publishing House of the Higher School of Economics. 2012; 526 p. (In Russ.)
  17. Heo S., Moser D.K., Lennie T.A., Riegel B., Chung M.L. Gender differences in and factors related to self-care behaviors: A cross-sectional, correlational study of patients with heart failure. Int. J. Nurs Stud. 2008; 45 (12): 1807–1815. doi: 10.1016/j.ijnurstu.2008.05.008.
  18. Oganov R.G., Simanenkov V.I., Bakulin I.G., Bakulina N.V., Barbarash O.L., Boytsov S.A., Boldueva S.A., Garganeeva N.P., Doshchitsin V.L., Karateev A.E., Kotovskaya Yu.V., Lila A.M., Lukyanov M.M., Morozova T.E., Pereverzev A.P., Petrova M.M., Pozdnyakov Yu.M., Syrov A.V., Tarasov A.V., Tkacheva O.N., Shalnova S.A. Comorbid pathology in clinical practice. Algorithms for diagnosis and treatment. Association of General Practitioners (Family Physicians) of the Russian Federation, National Medical Association for the Study of Combined Diseases, Professional Foundation for the Promotion of Medicine “PROFMEDFORUM”. Clinical guidelines. Kardiovaskulyarnaya terapiya i profilaktika. 2019; 18 (1): 5–66. (In Russ.) doi: 10.15829/1728-8800-2019-1-5-66.
  19. Pogosova G.V. Modern approaches to the diagnosis and treatment of depressive di­sorders in general medical practice. In: Kardiovaskulyarnaya terapiya i profilaktika. Metodicheskoe posobie dlya vrachey. (Cardiovascular therapy and prevention. Metho­dological guide for doctors.) M. 2007; 24 p. (In Russ.)
  20. Mukhtarenko S.Yu., Murataliev T.M., Neklyudova Yu.N., Zventsova V.K., Okunova A.A. Affect disorders and life quality in coronary heart disease patients under different treatment approaches. Kardiovaskulyarnaya terapiya i profilaktika. 2015; 14 (4): 18–21. (In Russ.) doi: 10.15829/1728-8800-2015-4-18-21.
  21. Anda R., Williamso D., Jones D., Macera C., Ea­ker E., Glassman A., Marks J. Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults. Epidemiology. 1993; 4 (4): 285–294. doi: 10.1097/00001648-199307000-00003.
  22. Ariyo A.A., Haan M., Tangen C.M., Rutledge J.C., Cushman M., Dobs A., Furberg C.D. Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group. Circulation. 2000; 102 (15): 1773–1779. doi: 10.1161/01.cir.102.15.1773.
  23. Izmozherova N.V., Po­pov A.A. Atherosclerosis risk factors in women with coro­nary heart disease developed before the age of 65 years. Rossiyskiy kardiologicheskiy zhurnal. 2008; (1): 61–64. (In Russ.) doi: 10.15829/1560-4071-2008-1-61-64.
  24. Plavinski S.L., Plavinskaya S.I., Klimov A.N. Social factors and increase in mortality in Russia in the 1990s: prospective cohort study. BMJ. 2003; 326 (7401): 1240–1242. doi: 10.1136/bmj.326.7401.1240.
  25. Vathesatogkit P., Batty G.D., Woodward M. Socioeconomic disadvantage and disease specific mortality in Asia: Systematic review with meta-analysis of population — based cohort studies. J. Epidemiol. Community Health. 2014; 68 (4): 375–383. doi: 10.1136/jech-2013-203053.
  26. Pollitt R.A., Rose K.M., Kaufman J.S. Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: A systematic review. BMC Public Health. 2005; 20 (5): 7. doi: 10.1186/1471-2458-5-7.
  27. Alcohol. World Health Organization. News bulletin. 2018. (access date: 11.01.2021). (In Russ.)
  28. Gardner J.D., Mouton A.J. Alcohol effects on cardiac function. Compr. Physiol. 2015; 5 (2): 791–802. doi: 10.1002/cphy.c140046.
  29. Pankuweit S. Alcohol consumption in women and the elderly: When does it induce heart failure? Herz. 2016; 41 (6): 494–497. doi: 10.1007/s00059-016-4462-0.
  30. Vorobieva O.V. Clinical features of depression in general medical practice (based on the results of the «COMPASS» program). Consilium Medicum. 2004; 6 (2): 154–158. (In Russ.)
  31. Dubinina E.A. Psikhicheskaya adaptatsiya pri serdechno-sosudistykh zabolevaniyakh: fenomenologiya, dinamika, prognoz. Uchebno-metodicheskoe posobie dlya vrachey i meditsinskikh psikhologov. (Mental adaptation in cardiovascular diseases: phenomenology, dynamics, prognosis. Study guide for doctors and medical psychologists.) RGPU im. A.I. Gertsena. SPb.: Kopi-R Grupp. 2013; 88 p. (In Russ.)
  32. Rutledge T., Redwine L.S., Linke S.E., Mills P.J. A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease. Psy­cho­som. Med. 2013; 75 (4): 335–349. doi: 10.1097/PSY.0b013e318291d798.
  33. Piepoli M.F., Corra U., Benzer W., Bjarnason-Wehrens B., Dendale P., Gaita D., McGee H., Mendes M., Niebauer J., Zwisler A.-D.O., Schmid J.-P. Secondary prevention through cardiac rehabilitation: From knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur. J. Cardiovasc. Prev. Rehabil. 2010; 17 (1): 1–17. doi: 10.1097/HJR.0b013e3283313592.
  34. Sharp J., Baillie N., Osborne M., Whitnall L., Sharp L. Outcome evaluation of brief psychosocial training for cardiac rehabilitation staff. J. Cardiopulm. Rehabil. Prev. 2007; 27 (2): 99–103. doi: 10.1097/
  35. Blumenthal J.A. Psychosocial training and cardiac rehabilitation. J. Cardiopulm. Rehabil. Prev. 2007; 27 (2): 104–106. doi: 10.1097/01.HCR.0000265038.69898.b0.
  36. Albus C., Jordan J., Herrmann-Lingen C. Scree­ning for psychosocial risk factors in patients with coronary heart disease-recommendations for clinical practice. Eur. J. Cardiovasc. Prev. Rehabil. 2004; 11 (1): 75–79. doi: 10.1097/01.hjr.0000116823.84388.6c.
  37. Russian Society of Cardiology. 2020 Clinical practice guidelines for Stable coronary artery disease. Rossiyskiy kardiologicheskiy zhurnal. 2020; 25 (11): 4076. (In Russ.)
  38. Ministry of Health of the Russian Federation. Clinical guidelines. Russian Society of Cardiology. Chronic heart failure. 2020; 183 p. (access date: 11.01.2021). (In Russ.)
  39. Mareev V.Yu., Fomin I.V., Ageev F.T., Arutyunov G.P., Begrambekova Yu.L., Belenkov Yu.N., Vasyuk Yu.A., Galyavich A.S., Garganeeva A.A., Gendlin G.E., Gilyarevsky S.R., Glezer M.G., Drapkina O.M., Duplyakov D.V., Kobalava Zh.D., Koziolova N.A., Lopatin Yu.M., Mareev Yu.V., Moiseev V.S., Nedoshivin A.O., Perepech N.B., Sitnikova M.Yu., Skibitsky V.V., Tarlovs­kaya E.I., Chesnikova A.I., Shlyakhto E.V. Clinical guidelines. Chronic heart failure (CHF). Zhurnal serdechnaya nedostatochnost. 2017; 18 (1): 3–40. (In Russ.) doi: 10.18087/rhfj.2017.1.2346.
  40. Belenkov Yu.N., Mareev V.Yu. Printsipy ratsional'nogo lecheniya serdechnoy nedostatochnosti. (Principles of rational management of heart fai­lure.) M.: Media Medica. 2001; 266 p. (In Russ.)
  41. Zaitsev V.P. Variant of the psychological test Mini-Mult. Psikhologi­cheskii zhurnal. 1981; (3): 118–123. (In Russ.)
  42. Zaitsev V.P., Ayvazyan T.A. Psychological resin test: use in clinical medicine (analytical review). Terapevticheskiy arkhiv. 2008; (4): 89–92. (In Russ.)
  43. Ya­khin K.K., Mendelevich D.M. Clinical questionnaire for the identification and assessment of neurotic conditions. In: Klinicheskaya i meditsinskaya psikhologiya. Prakticheskoe rukovodstvo. (Clinical and medical psychology. A practical guide.) М. 1998; 545–552. (In Russ.)
  44. Rector Th., Cohn J. Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, ­double-mind, placebo-controlled trial of pimobendan. Am. Heart J. 1992; 124 (4): 1017–1025. doi: 10.1016/0002-8703(92)90986-6.
  45. Ware Jr.J.E., Sherbourne C.D. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med. Care. 1992; 30 (6): 473–483. PMID: 1593914.
  46. Folstein M.F., Folstein S.E., McHugh P.R. Mini-­mental state. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975; 12 (3): 189–198. doi: 10.1016/0022-3956(75)90026-6.
  47. Denollet J. DS14: Standard assessment of negative affectivity, social inhibition, and type D personality. Psychosom. Med. 2005; 67 (1): 89–97. doi: 10.1097/01.psy.0000149256.81953.49.
  48. Morisky D.E., Green L.W., Levine D.M. Concurrent and predictive validity of a self-reported measure of medi­cation adherence. Med. Care. 1986; 24 (1): 67–74. doi: 10.1097/00005650-198601000-00007.
  49. Saunders J.B., Aasland O.G., Babor T.F., De La Fuente J.R., Grant M. Development of the Alcohol Use Di­sorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Comparative Study Addiction. 1993; 88 (6): 791–804. doi: 10.1111/j.1360-0443.1993.tb02093.x.
  50. The Order of the Federal State Statistics Service (Rosstat) No. 465, issued at 2 July 2014 “Methodological regulations for the calculation of indicators of monetary income and expenditure of the population”. (access date: 11.01.2021). (In Russ.)
  51. Kupper N., Denollet J. Type D personality as a prognostic factor in heart disease: assessment and mediating mechanisms. J. Pers. Assess. 2007; 89 (3): 265–276. doi: 10.1080/00223890701629797.
  52. Sogaro E., Schinina F., Burgisser C., Orso F., Pallante R., Aloi T., Vanni D., Pazzagli A., Fattirolli F. Type D personality impairs quality of life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation. Monaldi Arch. Chest Dis. 2010; 74 (4): 181–191. doi: 10.4081/monaldi.2010.259.
  53. Aronov D.M. Cardiac rehabilitation basic. Kardiologiya: novosti, mneniya, obuchenie. 2016; (3): 104–110. (In Russ.)

Supplementary files

Supplementary Files Action
Рис. 1. Усреднённые профили, выявленные по сокращённому многофакторному опроснику для исследования личности (СМОЛ), наблюдаемых (Т-баллы). Обозначение шкал СМОЛ: L — лжи; F — достоверности; K — коррекции; 1 (Hs) — ипохондрии; 2 (D) — депрессии; 3 (Hy) — истерии; 4 (Pd) — психопатии; 6 (Pa) — паранойяльности; 7 (Pt) — психастении; 8 (Se) — шизоидности; 9 (Ma) — гипомании

Download (32KB) Indexing metadata
Рис. 2. Результаты исследования уровня невротизации. Анкетирование с помощью клинического опросника для выявления и оценки невротических состояний (Яхин К.К., Менделевич Д.М., 1978). Обозначение шкал: ШТ — шкала тревоги; ШНД — шкала невротической депрессии; ША — шкала астении; ШИТР — шкала истерического типа реагирования; ШОФН — шкала обсессивно-фобических нарушений; ШВН — шкала вегетативных нарушений

Download (21KB) Indexing metadata
Рис. 3. Результаты оценки качества жизни по миннесотскому опроснику качества жизни у больных с хронической сердечной недостаточностью

Download (14KB) Indexing metadata
Рис. 4. Результаты оценки качества жизни по краткой форме опросника для оценки качества жизни (SF-36). Обозначение шкал: ФФ — физическое функционирование; РФОФС — ролевое функционирование, обусловленное физическим состоянием; ИБ — интенсивность боли; ОСЗ — общее состояние здоровья. Обобщающий показатель за 4 шкалы: ФКЗ — физический компонент здоровья; ЖА — жизненная активность; СФ — социальное функционирование; РФОЭС — ролевое функционирование, обусловленное эмоциональным состоянием; ПЗ — психическое здоровье. Обобщающий показатель за 4 шкалы: ПКЗ — психологический компонент ­здоровья

Download (33KB) Indexing metadata
Рис. 5. Модель психосоциальной адаптации к хронической сердечной недостаточности (ХСН) у пациентов с ишемической болезнью сердца. Социальный статус. Предписанный: пол, возраст. Приобретённый: уровень образование, профессия, должность, доход. Психологические факторы. Личностные особенности: профиль личности, тип личности. Аффективные нарушения: тревожно-депрессивные расстройства. Когнитивные нарушения: когнитивные функции. Качество жизни: изменение качества жизни. Клиническое течение: тяжесть ХСН согласно клиническим рекомендациям. Коморбидная патология: сопутствующие заболевания. Приверженность к лечению. факторы, на которые может оказывать влияние врач.

Download (43KB) Indexing metadata



Abstract - 6

PDF (Russian) - 0


Article Metrics

Metrics Loading ...



© 2021 Zhidyaevskij A.G., Galyautdinov G.S., Mendelevich V.D., Gataullina A.G., Kuzmenko A.O.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies