Assessment of disturbed functions in patients with chronic heart failure using International classification of functioning ICF categories

BACKGROUND: The evaluation of impaired functions in patients with cardiac diseases is traditionally based on the clinical signs of the disease and instrumental hemodynamic parameters, without affecting all other disorders that occur with this pathology. The International classification of functioning is based on the functioning of the patient in his/her environment; therefore, a consistent assessment of the entire complex of impaired functions of the patient is appropriate, allowing for a more accurate formulation of the goals of rehabilitation and controlling the main stages of rehabilitation.

AIM: To evaluate the International classification of functioning for assessing all impaired functions in patients with chronic heart failure.

MATERIALS AND METHODS: The study included 68 patients with decompensated chronic heart failure. The analyzed sample included patients with chronic heart failure stages 2B and 3 (NYHA classes III–IV). The average patient age was 63.9 years, and the average disease duration was approximately 7 years. The sample was predominantly men (66.5%). The etiology of chronic heart failure was represented by uncontrolled arterial hypertension (92%), post-infarction cardiosclerosis (74%), ischemic cardiomyopathy (25%), and chronic obstructive pulmonary disease (12%). Radiation diagnostic methods were used to confirm the severity of cardiac decompensation. The study assessed impaired functions in accordance with the domains of the International classification of functioning, mainly in “functions of the cardiovascular system”.

RESULTS: In this study, 68 patients had decompensated chronic heart failure stages 2B and 3 (NYHA classes III–IV). Group 1 included 40 patients, and group 2 included 28 patients. The instrumental examination revealed a more pronounced decrease in left-ventricular ejection fraction in group 1 compared with group 2 (42.8±4.4 and 49.2±5.6, respectively), showing a significant difference (p <0.05). Other hemodynamic parameters did not differ significantly in the groups. In the analysis of a basic set of the International classification of functioning domains for patients with chronic heart failure, the following domains turned out to be the most significant: heart function (b410), forced myocardial contraction (b4102); heart rate (b4100); blood supply to the heart (b4103); blood pressure functions (b420): increase (b4200), decrease (b4201), maintenance (b4202); functions of the respiratory system (b440) including the “respiratory rate” (b4400); additional functions and sensations from the cardiovascular and respiratory systems (b450-469); exercise tolerance functions (b455); water balance (b5450), including “water retention” (b45500), characterizing the presence of edematous syndrome; and muscle strength functions (b730). The indicated domains were also supplemented with Section d (activity and participation) — walking long distances (d4501) and doing housework (d640); and Domain e (environmental factors), i.e., help from the next of kin (e310).

CONCLUSIONS: A set of domains of the International classification of functioning for patients with decompensated heart failure has been developed and proposed, which makes it possible to more effectively identify the key problems of people with disability and more objectively form a plan for complex rehabilitation, which largely determines the prognosis in these patients.