The Value of Psychosocial Factors in Patient Selection and Outcomes after Heart Transplantation

Abstract

Heart transplantation remains the gold standard treatment for advanced heart failure, although its use is limited by donor organ availability. To ensure that the rare resource of a donor heart is allocated appropriately, the evaluation of the heart transplant candidates includes extensive medical and psychosocial assessments. These psychosocial factors are critically important to understand pre-heart transplant because it is known that psychosocial evaluation and psychosocial comorbidities have a strong association with post-heart transplant outcomes. The critical factors to assess are psychological functioning, adherence to medical recommendations, and social support. These factors are likely inter-related and have been shown to have an effect on the health-related quality of life and overall survival. Recently, new tools have been developed to standardize the evaluation process. In this review, we will discuss the tools available to assess psychosocial factors in the transplant candidate and discuss the role these factors have on post-heart transplant outcomes.

Adherence of Heart Transplant Recipients to Prescribed Medication and Recommended Lifestyle Habits

“…Generally, heart transplantation is associated with a significant improvement in QOL and this could be partially explained by symptomatic improvement, psychologic well-being, and improved QOL after surgical intervention. 11,13 However, heart transplantation is also followed by a decline in emotional well-being, with a prevalence of 33% of depressive disorders being reported after heart transplantation. 14 Nonadherence to prescribed medications after transplantation was related to self-reported nonadherence to medication before transplantation, low social support, higher level of education, a low value of conscientiousness, and not living in a stable relationship.…”

Psychosocial Evaluation in Patients Undergoing Left Ventricular Assist Device Implantation Using the Transplant Evaluation Rating Scale

“…Psychosocial evaluation has been crucial in heart transplant candidates since post-transplant outcomes are significantly associated with psychological functioning. [14,15] However, it remains unclear which evaluation tool is most pertinent to patients undergoing LVAD implantation. [16] Psychosocial evaluation prior to LAVD implantation is essential in the selection of candidates for advanced surgical therapy.…”

Physical rehabilitation of patients after heart transplantation

“…С одной стороны, показано, что уровень образования, более высокий соци-альный и экономический статус являются предикторами ОБЗОРЫ § лучшей выживаемости, а низкая приверженность к меди-цинским рекомендациям и отсутствие социальной под-держки ассоциированы с неблагоприятным прогнозом после ТС [44]. Поэтому предлагается для надлежащего использования дефицитного ресурса -донорских сердец при отборе реципиентов использовать оценку психосо-циальных факторов [45]. С другой стороны, в недавно проведенном анализе влияния психосоциальных факто-ров на результаты ТС оказалось, что среди 345 пациен-тов ни один из психосоциальных факторов не имел вли-яния на долговременный (10-летний) прогноз после ТС.…”