8 Long-term treatment, and living with cardiovascular diseases

8.4 When surgery is required

For some cardiovascular disease patients, surgery may be carried out as an emergency procedure or become an inevitable progression, following on from drug therapy. There are various degrees of surgery carried out, ranging from the fairly routine and minorly invasive procedure of coronary angioplasty to the major life-saving heart (or heart and lung) transplant. While it is important to understand all of the detail of surgical procedures and how the cardiac surgical team work together, it is also equally important to consider surgery from the position of the cardiovascular disease patient.

For some individuals, simply having a blood sample taken is a stressful procedure, so the psychological as well as the physiological effects of any minor or major surgical procedures need to be considered. In addition, how a patient recovers and embraces the required lifestyle management and complies with further ongoing drug therapy can be influenced by psychosocial factors. Psychologists have found from studies of patients recovering from MI that depressed patients were three times more likely to die within a year than those who were not depressed, unrelated to the initial severity of their disease (Frasure-Smith et al., 1999). The same authors published another study showing that depressed patients who thought that they did not get enough support at home had the highest death rates. From a more positive angle, researchers on the Recurrent Coronary Prevention Project, which randomly allocated over 1000 MI patients to receive either routine medical care or the same care with additional counselling about risk factors or group therapy with behaviour modification, found a 44 per cent reduction in the incidence of second MIs in the latter group (Friedman, 1989).

By choice or default, physicians, nurses and allied health professionals are the ones who need to take responsibility for systematically and effectively addressing patients’ psychosocial needs… There aren't enough psychologists who are trained in the ins and outs of life with cardiovascular illness. It's a huge area of unmet need.

(Wayne Sotile, Wake Forest University Cardiac Rehabilitation Program; quoted in Clay, 2001)  ©

While this quotation is just an opinion, it nevertheless makes an important point. It emphasises that health care professionals can provide support and advice on recovery and coping skills that are beneficial to cardiovascular disease patients, in addition to standard medical care.

Following successful surgery, it remains essential to control the symptoms and further development of cardiovascular diseases.