An Intervention Trial for Strengthening Medical Adherence after Heart Transplantation

Abstract

Introduction In heart transplant recipients, nonadherence is associated with higher risk of morbidity and mortality. Research Question Can a psychoeducational intervention enhance adherence to medical recommendations? Design We randomized 200 patients awaiting heart transplantation on the high urgency wait list to a manualized psychoeducational intervention or standard care. Follow-up continued to three years after transplantation. Primary endpoint was adherence to immunosuppressive medication, assessed at 3, 6, 12, 24, and 36 months posttransplant. Secondary endpoints were barriers to adherence during follow-up and clinical outcomes, including cardiac rejection within the first postoperative year and postoperative 3-year mortality. Results Fifty patients died before or within the first 3 months of transplantation. The primary endpoint was analyzed in 66 patients in the intervention group and 66 in the control group. Both study groups showed almost maximal adherence to immunosuppressive medication throughout follow-up, with no significant time x treatment interaction (P>0.99). Likewise, there was no significant time x treatment interaction ( P=0.41) on barriers to adherence. The percentage of patients with International Society for Heart and Lung Transplantation standard grade 1 and 2 rejection was in the intervention and control groups 82.5% and 78.7%, respectively, and 8.8% and 13.1%, respectively, without significant differences between study groups ( P=0.75). Considering all randomized and transplanted patients in the intervention group (N=85) and control group (N=87), postoperative 3-year mortality was 29.4% and 27.6%, respectively ( P=0.82). Conclusions Adherence to immunosuppressive medication was high, even without a complex, manualized psychoeducational intervention. The intervention had no significant positive impact on cardiac rejection and mortality.

Clinical experience with medical hypnosis as an adjunctive therapy in heart surgery

“…The “journey to the heart” script helps patients reframe their worry to a sense of caregiving. In trance, patients are invited to make gentle contact with their heart in a quiet space, listening with growing self-confidence to what it might wish to say and perhaps taking the opportunity to respond ( Tigges-Limmer and Schmid-Ott, 2012 ).…”

Der lange Weg in ein Leben mit einem neuen Herz

“…Auch nach der Transplantation werden Schulungen in standardisierter Form angeboten, die das Leben mit dem kürzlich transplantierten Organ im Fokus haben. Die Vermittlung erfolgt nach dem eigens entwickelten interdisziplinären Schulungsprogramm „Specific Active Refinement of Adherence of Heart Transplant Patients (SARAH)“ 24 28 . Dazu gehören unter anderem verschriftlichte Informationen für die häusliche Umgebung sowie praxisnahe Hinweise und Beratungen etwa über angemessene Ernährung, hygienische Verhaltensweisen oder das Management der medikamentösen Versorgung.…”

“…Von höchster Bedeutung sind insbesondere die Ablaufsteuerung durch die HTX-Koordination sowie die umfassende Betreuung durch das psychologische Team 16 28 . Neben dem ärztlichen und therapeutischen Dienst braucht es vor allem auch bei den Pflegenden 29 grundsätzlich ein hohes Maß an Spezialisierung und insbesondere einer strukturierten Einarbeitung 30 .…”

Donor and Donation Images (DDI)—A Scoping Review of What We Know and What We Don’t

“…There is research on transplantation-associated psychological factors of organ donors (see e.g., [2][3][4][5][6]) and on psychological factors associated with the procedure on the organ recipients' side as well (see e.g., [7][8][9][10]). Studies show that, in terms of psychological distress, the most frequently reported symptoms among organ recipients are anxiety symptoms (particularly fear of organ rejection, repeated surgery, and death) and symptoms of depression [11][12][13]. In addition, up to 16% of individuals show post-traumatic stress disorder (PTSD) following transplantation with symptoms such as scenic re-experiencing of events, emotional overload, nightmares, high internal tension, withdrawal, and avoidance behavior [14,15].…”