| Objective To study the effect of cognitive-behavioral therapy on the anxiety, depression, quality of life, clinical efficacy and length of stay for the inpatients with coronary heart disease. To provide a scientific basis for improving the psychological care of patients with coronary heart disease; To explore a new approach and methods for improving the quality of care in patients with coronary heart.Mathods A total of 80 subjects with coronary heart came from a 3 A level hospital in a city, they were hospitalized from November, 2008 to June, 2009. Inclusion criteria: 1. The final diagnosis patients with diagnosed coronary heart disease in accordance with the 1999 International Society of Cardiology and the WHO diagnostic criteria for coronary heart disease;2. Primary schools and/or higher education level; 3. No mental illness, conscious disturbance and cognitive impairment; 4. No serious cerebrovascular complications; 5. No other system of serious illness; 6. Volunteer to participate in this study. The 80 cases patients meeting the above criteria were randomized to control group or test group. 40 patients were enrolled into Control group (6 cases of acute myocardial infarction, angina pectoris in 23 cases, arrhythmia in 5 cases, 6 cases of ischemic cardiomyopathy); 40 patients were enrolled into Test group (7 cases of acute myocardial infarction, angina pectoris in 24 cases, arrhythmia in 4 cases, 5 cases of ischemic cardiomyopathy). The comparison of heart functions without a statistically significant difference between the two groups (P>0.05), there is also no statistically significant difference in gender, age, married status, education level, occupation, source of hospitalization income, area of residence between the two groups (P>0.05).The Control group was received routine cardiovascular care; the test group was received routine care plus cognitive-behavioral intervention. Cognitive-behavioral intervention mainly include: 1. Rational emotive therapy. To find the irrational beliefs resulting in negative emotions to the patients, help them learn to replace the irrational beliefs with the Reasonable beliefs and reduce or eliminate negative feelings via discussing the irrational beliefs with the patients. 2. Relaxation training. Using the method of oral guidance, enable the patients to do deep breath and relax muscles slowly, and to eliminate the psychological anxiety-depression and stress as far as possible through allowing them in accordance with the instruction of researcher. Cognitive-behavioral intervention was implemented mainly in a one to one communication manner, and carried out combining with the hospital conditions and patient's actual situation. Starting from the patient's admission to the discharge, they received intervention once every three days, 15-30 minutes at every turn; the average interventions were 4 times per patient. When they were hospitalized, two groups of patients were evaluated with the general information questionnaire, the condition assessment form, SDS, SAS, and SF-36 short-form health survey questionnaire respectively. When discharged from hospital, the two group patients were took SDS, SAS, SF-36 Short-form health survey questionnaire and evaluated the clinical efficacy and electrocardiogram (ECG), and the length of stay, heart rate and blood pressure were recorded at the time of discharge. The raw data was input into computer, SPSS11.5 was used for statistical description and analysis. T-test was used to analyses the data of anxiety, depression, and various dimensions of quality of life, heart rate, blood pressure and length of stay. The heart functions date was analyzed by using Wilcoxon signed rank test. The clinical efficacy and improvement of ECG data was analyzed by using chi square test.Result 1. The level of anxiety-depression was compared before and after the intervention between the two groups. 60% of patients had anxiety before the intervention in the test group, this data had fallen to 42.5% after the intervention; 62.5% of patients had anxiety before the intervention in the control group, the data had no changes after intervention. 42.5% of patients had depression before the intervention in the test group, this data had fallen to 32.5% after the intervention; 37.5% of patients had depression before the intervention in the control group, the data had increased to 65% after intervention.2. The data of anxiety, depression, quality of life, heart rate and blood pressure was analyzed by using Independent-Samples T test before and after the intervention between the two groups. There were no statistically differences in the data of anxiety, depression, dimensions of quality of life, heart rate and blood pressure before the intervention between the two groups (p>0.05). There were statistically differences in the data of anxiety, depression, heart rate, blood pressure and dimensions of quality of life (except for mental health dimension of quality of life) after the intervention between the two groups (p﹤0.05). 3. The data of anxiety, depression, quality of life, heart rate and blood pressure was analyzed by using Paired-Samples T Test before and after the intervention between the two groups. There were statistically differences in the data of anxiety, depression, dimensions of quality of life, heart rate and blood pressure before and after the intervention in test group (p﹤0.05). There were no statistically differences in the data of anxiety, depression, heart rate, blood pressure and dimensions of quality of life (except for physiological function and social function dimensions of quality of life and systolic blood pressure) before and after the intervention in the control group (p>0.05). 4. The clinical efficacy and improvement of ECG data was analyzed by using chi square test after the intervention between the two groups. There were statistically differences in the data of clinical efficacy and improvement of ECG after the intervention in the two groups (p﹤0.05). 5. The data of length of stay was analyzed by using Independent-Samples T test after the intervention in the two groups, there were no statistically differences in the data of length of stay in the two groups (p>0.05).Conclusion1. Cognitive-behavioral intervention could alleviate the negative feelings of the patients, e.g. anxiety, depression and so on.2.Cognitive-behavioral intervention could improve the quality of life in the patients with coronary heart disease.3. Cognitive-behavioral intervention could improve the clinical efficacy and ECG, decrease the hear rate and blood pressure in the patients with coronary heart disease.4. Cognitive-behavioral intervention has no significant effect for shortening the length of stay in the patients with coronary heart disease.5. This study explores a new approach and methods for improving the quality of care in patients with coronary heart. Cognitive-behavioral intervention can be spread for clinical nursing in the patients with coronary heart disease.
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