Prediction of survival on the waiting list for heart transplantation and of posttransplant nonadherence—Results of a prospective longitudinal study

Abstract

Background Only a few previous studies have focused on the interaction between pretransplant psychological variables, survival on the waiting list, and adherence to therapy after heart transplantation (HTx). Methods This work combined two studies: Study 1 monitored survival of patients on a HTx waiting list (n = 50) and study 2 examined barriers to adherence after HTx (subgroup of n = 20). All patients were evaluated immediately after listing for HTx (T0). Those in study 2 were also evaluated immediately after HTx (T1) and after 6 months (T2). Psychosocial functioning was measured by the Transplant Evaluation Rating Scale (TERS), and depression and anxiety by Patient Health Questionnaire and Hospital Anxiety and Depression Scale. Barriers to immunosuppressive adherence post‐HTx were measured by the Medication Experience Scale for Immunosuppressants (MESI). Results According to the TERS classification of Rothenhäusler et al, patients were divided into three groups in study 1. Compared with inconspicuous patients (n = 23) and risk patients (n = 21), high‐risk patients (n = 6) demonstrated a higher mortality (log‐rank test of trend, P = 0.002). In study 2, there was a strong correlation between the TERS (T0) and the MESI (T2) (r = 0.84, P = 0.001). Conclusions The TERS may serve as a predictor of survival on the waiting list. There is need for further longitudinal data with larger sample sizes.

Adherence to Immunosuppression Medications among Heart Transplant Recipients: Challenges, Opportunities, and Potential Role of Digital Approaches in the COVID-19 Era

“…Whereas the medical effects of COVID-19 are several, the social effects of the pandemic may lead to a number of additional challenges related to adherence behavior. Poor psychosocial functioning [11], lack of social support [12] and worse mental health [13] are known correlates to low adherence to immunosuppressants among adult heart transplant recipients. Additionally, immunosuppressants can be costly with the need for insurance coverage, and taking these medications as recommended requires a high level of health literacy to incorporate effectively in daily routine.…”

The Approach to the Psychosocial Evaluation of Cardiac Transplant and Mechanical Circulatory Support Candidates

“…Pre-transplant depression was not related to missing posttransplant clinical follow-up appointments, occurrence of graft rejection, or duration of survival, although it increased patients' risk for rehospitalization [13]. Vitinius et al [12] found a strong association between pre-transplant anxiety symptoms and post-transplant perceptions of medication adherence barriers, but the association was not statistically significant due to their very small sample size.…”

“…There were also no reliable relationships to clinical outcomes including graft rejection, length of hospital stay after transplant, time to rehospitalization, total hospital days, or number of rehospitalizations [41,42]. Two studies found no effect on mortality [40,41]; the third study reported equivocal evidence, depending on the method used to calculate "high-risk" using the psychosocial rating tool score [12].…”

“…Several single-site studies have focused on heart recipients. Two small investigations (with sample sizes less than 50) reported that patients with elevated pre-transplant depression symptom scores were at higher risk for post-transplant adherence-related problems, including patient perceptions that they faced more barriers to immunosuppressant medication adherence [12], and poorer actual medication adherence [13]. Pre-transplant depression was not related to missing posttransplant clinical follow-up appointments, occurrence of graft rejection, or duration of survival, although it increased patients' risk for rehospitalization [13].…”

“…In the three studies of heart recipients (one using the TERS, one using the PACT, and one using the SIPAT), patients identified as being at "high psychosocial risk" based on their score on the rating tool were more likely post-transplant to experience incident depressive disorder [41], be nonadherent to clinical followup appointments [42], and possibly to perceive more barriers to immunosuppressant medication adherence [12]. However, this latter finding held only at one of two assessed time points.…”