SUMMARY This paper reports on the use of the Nottingham Health Profile as a measure of patient quality oflife before and after combined heart and lung transplantation at Harefield Hospital. A total of 125 profiles from 48 patients were analysed. In both section 1 and section 2 of the profile, large and statistically significant (p < 0 05) improvements in quality of life were associated with transplantation. The profile proved easy to use either as part of an interview during assessment for transplantation or as a postal follow-up postoperatively.A recent development in cardiothoracic surgery has been the advent of combined heart and lung transplantation. ' This procedure offers a new mode of therapy for patients with primary pulmonary hypertension, pulmonary vascular disease or parenchymal lung disease. The role of this form of therapy has not yet been established. Several factors need to be considered when evaluating such a procedure, including the effect on patient survival, symptoms, functional capacity and quality of life. The aim of this paper is to report on our initial experience using the Nottingham Health Profile (NHP) with heart-lung transplant recipients at Harefield Hospital.
Patients and MethodsAs of January 1987 a total of 78 patients had undergone combined heart-lung transplantation at Harefield Hospital. The majority of these patients (66 7%) were female and the mean age (±SD) was 23-8 (± 13 1) years. A total of 48 patients completed the health profile as part of a larger interview at assessment for transplantation. The remaining 30 patients were ineligible for this study, mainly for reasons of age and nationality: the questionnaire has not been validated for use in foreign translation,2 and is therefore restricted to English-speaking patients; it also requires a minimum reading age of 12 years and hence is not applicable to young children. Of the 30 ineligible patients, 46% were overseas patients, 39% were paediatric cases and 14% were too ill prior to operation to partake in the study.The study design was observational rather than experimental. In the absence of a randomised nontreatment comparison group the aim was to take repeated measures for each patient both before and after transplantation. Each patient's pre-transplant profile score therefore serves as a reference point for his or her subsequent scores. The NHP was administered by interview at assessment and at 3-monthly intervals prior to operation. Post-transplant completion of the profile was by postal follow-up (self-completion) at 3, 6 and 12 months after operation. Of the 48 patients who completed the pre-transplant profile, 32 had survived for three months or more at the time of study. Of those surviving, 28 patients completed the profile at 3 months post-transplant (response rate 88%
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