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An Intervention Trial for Strengthening Medical Adherence after Heart Transplantation.
Tigges-Limmer, K; Stock Gissendanner S, S; Schmid-Ott, G; Wlost, S; Gummert, J F; Zittermann, A.
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  • Tigges-Limmer K; Clinic for Thoracic and Cardiovascular Surgery, 39059Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
  • Stock Gissendanner S S; Social Sciences Faculty, 9375Georg August University, Göttingen, Germany.
  • Schmid-Ott G; 219487Berolina Klinik, Löhne, Germany.
  • Wlost S; Clinic for Thoracic and Cardiovascular Surgery, 39059Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
  • Gummert JF; Clinic for Thoracic and Cardiovascular Surgery, 39059Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
  • Zittermann A; Clinic for Thoracic and Cardiovascular Surgery, 39059Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
Prog Transplant ; 32(2): 129-137, 2022 06.
Article en En | MEDLINE | ID: mdl-35361008
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Corazón / Trasplante de Riñón / Trasplante de Pulmón Tipo de estudio: Clinical_trials / Guideline Límite: Humans Idioma: En Revista: Prog Transplant Asunto de la revista: ENFERMAGEM / TRANSPLANTE Año: 2022 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Corazón / Trasplante de Riñón / Trasplante de Pulmón Tipo de estudio: Clinical_trials / Guideline Límite: Humans Idioma: En Revista: Prog Transplant Asunto de la revista: ENFERMAGEM / TRANSPLANTE Año: 2022 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Estados Unidos