Psychological, Social, and Medical Factors Affecting Rehabilitation Following Coronary Bypass Surgery

Article excerpt

Coronary bypass surgery was developed in 1967 (Thurer, 1980) and is now performed on more than 350,000 individuals annually (Possanza, 1996). One of the many goals of coronary bypass surgery is the return of the patient to gainful employment (Allen, 1990). Though not a cure, the procedure is intended to alleviate symptoms of atherosclerotic heart disease and to improve quality of life.

Atherosclerotic heart disease is defined as an occlusion or blockage due to a buildup of plaque in the arteries which supply blood to the heart muscle. Symptoms of atherosclerotic heart disease include but are not limited to, angina pectoris (chest pain) or pain radiating down either arm, and possibly neck and or jaw pain (Falvo, 1991). Atherosclerotic heart disease can also be present with no symptoms at all (Falvo, 1991).

Coronary bypass surgery has considerable impact on the occupational status of individuals postoperatively (Rimm, Barboriak, Anderson, & Simon, 1976). Percentages of individuals returning to gainful employment following coronary bypass surgery are well below expected results despite the fact that 90% of individuals experiencing angina pectoris (chest pain) before coronary bypass surgery feel better physically after the operation (Russell, Abi-Mansour, & Wenger, 1986). However, many individuals choose not to work following coronary bypass surgery (Russel et al., 1986); they look back on their lives and decide to change their priorities, placing more value on human closeness and devaluing work (Thurer, Levine, & Thurer, 1980). Employment status prior to coronary bypass surgery is most predictive of the individual's work status after surgery. Individuals who were employed prior to surgery tend to return to work more often postoperatively (Allen, 1990; Caine, Harrison, Sharples, & Wallwork, 1991; Rogers et al., 1990; Russell et al., 1986).

Research by Russell et al. (1986) of individuals who had coronary bypass surgery at the University of Alabama in Birmingham found that over one fifth had a decrease in the number of work hours one year after surgery. P4rom the large number of individuals with heart disease only 11 to 20 percent participate in cardiac rehabilitation programs (Cardiac Rehabilitation Guideline Panel [CRGP], 1995).

The psychological, social and medical factors affecting length of recovery time and employment of individuals following coronary bypass surgery are discussed, as well as the importance for rehabilitation professionals understanding of the individual's functional capacities regarding employment following coronary bypass surgery. Finally, an accommodation which employers can make to enhance the re-employment of individuals following coronary bypass surgery is presented.

Psychological Factors

Cardiac rehabilitation exercise training can improve a patient's psychological status and functioning, though exercise training does little to reduce the levels of anxiety and depression commonly experienced by an individual recovering from coronary bypass surgery (CROP, 1995). To achieve maximum benefits from cardiac rehabilitation, psychological counseling must be included (Denollet, 1993a).

Psychological counseling included within the cardiac rehabilitation program serves two purposes, first to optimize psychosocial recovery, such as work and sexual relations, and second to prevent secondary coronary heart disease. Hagen (1991) noted that psychological adjustment problems experienced by individuals recovering from coronary bypass surgery affect the resumption of employment, psychosocial adaptation, and sexual functioning. The second purpose of psychological counseling involves providing behavioral change through identification of stressors which affect the individual (Bennett & Carroll, 1994) and management of risk factors through dietary, smoking, and physical activity change (Denollet, 1993b; McGee, 1994). Psychological counseling can facilitate change in all of the above risk factors. …