Objectives: Non-adherence which is a multifactorial concept can cause severe health problems in
heart transplant (HTX) patients, e.g. acute rejections of the graft. A baseline study
of compliance related complications was needed for creating a special adherence increasing
training. Information about adherence to the physicians' recommendations on medication,
smoking cessation, alcohol consumption, a lifelong relatively germfree diet, restrictions
regarding pets and, as further studies showed, data of emotional well-being and contact
to the HTx ambulant physician were needed.
Methods: In this anonymous cross-sectional study 920 HTX patients of HDZ-NRW were contacted
by postal survey. A total of 505 patients (aged 18 – 90 years) completed questionnaires
to medication adherence (ITAS, ITBS, COMPAD), fears and depression (HADS-D), quality
of life (SF-12), PTSD (posttraumatic stress disorder) (IES-R), germ-rich food and
pets.
Results: In the ITAS 17.3% of the patients reported an easily limited and 10.4% a precariously
limited adherence. Mental quality of life and age were generated as predictors for
medication adherence (ITAS) by logistic regression analysis (resulting correlation
coefficients: 0.016 and 0.017). A third of the patients admitted to occasionally eat
germ-rich food, 15% (N = 71) indicated to believe that germ-rich food would not harm
them. Anxiety and depressiveness correlated with physical (r =-.166**, r =-.232**)
and mental (r =-.665**, r =-.411**) quality of life, no significant correlations to
pets or generally germ-rich food was found. 7.8% of the patients suffered from PTSD
and 46.4% reported a minor stressful event. Most patients titled the symptoms of heart
disease, other diseases, rejections and the HTX as stressful. An age-effect comparable
to the normal population was not found (r =-.025). Correlations of PTSD and mental
(r =-.282**) or physical (r =-.422**) quality of life were significant.
Conclusion: Interventions to increase post-transplant adherence should refer to the alarmingly
high rate of non-adherence to medication and include an extra educational part referring
to germfree diet as well as pets. To influence the mental quality of life as a predictor
for medication adherence special psychological interventions need to be offered to
all patients suffering from anxiety, depression or PTSD. Further attention should
be paid to young patients as the second predictor. Hence, an educational, psychological
and advisory training will be needed.
