Life In Heart Transplant Recipients Research Articles

The association between body mass index, exercise capacity, and health-related quality of life in heart transplant recipients.

Pre-transplant obesity and weight gain after heart transplantation are both associated with increased risk of poor clinical outcomes. We aimed to assess the association between overweight or obesity, exercise capacity, and health-related quality of life in heart transplant recipients. This study is based on baseline data from the IronIC trial, in which we randomized 102 heart transplant recipients with iron deficiency to ferric derisomaltose or placebo. We performed cardio pulmonary exercise testing in all participants. To assess quality of life, we used the SF-36v2 questionnaire, using two sum scores: the physical component summary and the mental component summary. A minimal clinically important difference was defined as ≥2 and ≥3 for the physical and the mental component summary, respectively. 24/102 heart transplant recipients (24%) had a body mass index (BMI) ≥30 kg/m2. Peak oxygen consumption was 17.3 ± 4.6 ml/kg/min in the obese group vs. 24.7 ± 6.4 ml/kg/min in the group with a BMI <30 for a between-group difference of 7.4 (95% confidence interval 4.7-10.2) ml/kg/min: p < 0.001. The physical component summary score was on average 5.2 points lower in the patients with a body mass index ≥30 than in the lower weight group (p = 0.04). Almost a quarter of our heart transplant recipients in long-term follow-up had a BMI ≥30 kg/m2. These patients had substantially lower exercise capacity and lower quality of life in the physical domain.

(1088) - The Association Between Body Mass Index, Exercise Capacity, and Health-Related Quality of Life in Heart Transplant Recipients

(1088) - The Association Between Body Mass Index, Exercise Capacity, and Health-Related Quality of Life in Heart Transplant Recipients

Health-Related Quality of Life in Heart Transplant Recipients: A Review

Organ transplantation is a therapeutic alternative for patients with end-stage organ failure resulting from chronic or acute disease. In this context, health-related quality of life is an important multidimensional concept to evaluate the benefits of transplantation. To identify changes in health-related quality of life experienced by heart transplant patients. Systematic review of cross-sectional, prospective, qualitative studies published in English from January 2020 to December 2022 in Cochrane Library, Medline, OVID, PubMed, and Web of Science, following PRISMA guidelines. We identified forty-three articles, 21 cross-sectional, 10 prospective, and 12 qualitative, in addition to including information on the pre-transplant stage. A significant favorable change in most quality-of-life parameters is verified, which is persistent even after 20 years. Heart transplantation represents a successful therapeutic alternative that not only prolongs life but also makes it possible to achieve an adequate health-related quality of life. Family and social support are crucial elements that impact adjustment and quality of life during the pre- and post-transplant process.

Quality of Life of Heart Transplant Patients During the COVID-19 Pandemic

Abstract: The objective of this study was to evaluate the quality of life of heart transplant recipients during the pandemic of COVID-19 through a cross-sectional, descriptive and quantitative study. Individuals under treatment in a tertiary cardiology hospital in the city of São Paulo (SP) were included. The sample was 40 transplanted individuals with a time frame of more than one year and age over 18 years. The instrument was the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) from October 2021 to January 2022. After data collection, a compilation was made with descriptive analysis of the variables and calculation of the instrument, obtaining as a final result the calculation of the mean and standard deviation. The results highlighted the importance of improvements in several facets of each domain and public issues related to public transportation and daily life safety. It was possible to observe numerous difficulties in relation to the availability and ease of access in various sectors, a situation that also led to changes in the perception and quality of health as a whole, with sudden changes in the population’s daily lives. The study was satisfactory, making it possible to evaluate points of improvement in the quality of life of heart transplant recipients during the pandemic of COVID-19.

Double Product and Autonomic Function as Predictors of Quality of Life in Heart Transplant Recipients: A Cross-Sectional Study.

IntroductionHeart rate control by the autonomic nervous system (ANS) is impaired in heart transplant (HT) recipients, leading to increased resting heart rate, metabolic demand, and fatigue, which can impair their quality of life (QoL). In this study, we hypothesized the association of hemodynamics and autonomic function as predictors of QoL in HT recipients.MethodsThis is a cross-sectional study conducted with HT recipients aged ≥ 18 years at ambulatorial accompaniment. Blood pressure was used for hemodynamics assessment, and heart rate variability (HRV) was used for ANS assessment. QoL was assessed by the 36-item Short Form Health Survey. The significance level was set as P≤0.05.ResultsTwenty-two volunteers were included in the study. Systolic blood pressure (SBP) and double product (DP) were significantly negatively associated with the physical functioning domain of QoL. DP, the number of consecutive normal RR interval differences > 50 ms (NN50), and the percentage of normal RR intervals that differed by > 50 ms from the adjacent interval (PNN50) exhibited negative association with the physical role domain. NN50 and PNN50 were significantly associated with bodily pain, social functioning, and emotional role domains. SBP was negatively associated with the vitality domain. Considering general and mental health domains, no variable demonstrated significant association. DP, NN50, and PNN50 were negatively associated with the total score of QoL.ConclusionThis study demonstrated DP and HRV as predictors of QoL in HT recipients. These innovative results can become a relevant therapeutic target for improving QoL in HT recipients prior to its deterioration.

Health-Related Quality of Life of Heart Transplant Recipients Living in a Developing Country

BackgroundHeart transplantation (HT) is the treatment for patients with end-stage heart failure (HF). It is hoped that the procedure increases both survival rates and the level of health-related quality of life (HRQoL), which may, however, be compromised by post-transplant complications. The objective of this study was to analyze the level of HRQoL in HT recipients and considered the influence of variables from social and clinical contexts. Materials and MethodsThis is a cross-sectional study of HT recipients. The level of HRQoL was assessed by the World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaire during outpatient consultation. ResultsThis study analyzed 186 HT recipients from a total of 192 eligible patients. The median level of HRQoL was ≥67.8 points in all domains of the WHOQOL-BREF questionnaire (physical, psychological, social relationships, and environment) and general score of perception of the level of quality of life (QoL) and health. Variables such as age, ethnicity, per capita income, time from last hospitalization, number of current medications, and number of hospitalizations after HT were significantly related to at least 1 domain of the WHOQOL-BREF. ConclusionIn this study, HRQoL of HT recipients living in a developing country can be considered satisfactory given the high score obtained in all domains of WHOQOL-BREF and in the perception of the level of QoL and health.

Updates on Heart Transplantation

The purpose of this review is to provide a comprehensive update on recent advances in heart transplantation. Heart transplantation is now an established therapy for end-stage heart failure, though challenges still exist. However, multiple advances over the past few years will improve the survival and quality of life of heart transplant recipients. These advances include acceptance of previously considered marginal donor hearts, revisions to the donor heart allocation policy, advances in desensitization regimens, tailoring of immunosuppression regimens, and improvement in the diagnosis of rejection and allograft vasculopathy. Heart transplantation is evolving to provide better quality of life and survival to higher risk recipients with methods to broaden the donor pool, make the best use of existing organs, and refine the management of sensitization and diagnosis of rejection and allograft vasculopathy.

Prevalence of Iron Deficiency in Heart Transplant Recipients

Purpose Many heart transplant recipients have reduced exercise capacity and health-related quality of life, despite good over-all results regarding graft function. We believe iron deficiency (ID) to be one of several peripheral factors to have an impact on exercise capacity in heart transplant recipients, unrelated to hemodynamic dysfunction. In the general population, ID is defined as serum ferritin Methods We assessed parameters of iron metabolism in 169 stable heart transplant recipients at their annual follow up, at least one year after transplantation. ID was defined as s-ferritin Results Study demographics are presented in the Table. 81 patients (48 %) had ID defined as serum ferritin 4.0 µg/l, and 29 patients (17 %) had an sedimentation rate (SR) > 20 mm. Ferritin was weakly associated with SR (r = 0.24; p = 0.002) as well as estimated GFR (r = -0.22; p = 0.004) and age (r = 0.17; p = 0.02). Conclusion ID is prevalent in heart transplant recipients. Trials should be initiated to evaluate whether intravenous iron substitution can improve functional capacity and quality of life in heart transplant recipients with ID.

Relationship Between Patient-Perceived Treatment Burden and Health-Related Quality of Life in Heart Transplant Recipients

Patient-perceived treatment burden (i.e., the work of being a patient) and its relationship to health-related quality of life (HrQOL) have not been well studied, particularly in transplant recipients. We sought to evaluate patient-perceived treatment burden and its association with mental and physical HrQOL following heart transplant (HTx).

(828) - Parasympathetic Reinnervation Accompanied By Improved Post-Exercise Heart Rate Recovery and Quality of Life in Heart Transplant Recipients

Purpose: Although sympathetic reinnervation is accompanied by the improvement of exercise tolerability during several years after heart trans-plantation (HTx), little is known about parasympathetic ...

Effect of moderate- versus high-intensity exercise on vascular function, biomarkers and quality of life in heart transplant recipients: A randomized, crossover trial

Growing evidence in long-term treatment of heart transplant (HTx) recipients indicates effects of high-intensity interval training (HIIT) on several parameters, including oxygen uptake, vascular function and psychological distress. In this study we compare the effect of HIIT vs continued moderate training (CON) on vascular function, biomarkers and health-related quality of life (HRQoL) in HTx recipients. A randomized, controlled crossover trial of stable HTx recipients >12 months after transplantation was done on patients with 12 weeks of HIIT or 12 weeks of CON, followed by a 5-month washout and crossover. Outcomes included endothelial function, arterial stiffness, biomarkers, HRQoL and markers of anxiety and depression. Sixteen HTx recipients (mean age 52 years, 75% male) completed the study. HIIT increased VO(2peak) more than CON (between-group difference, p < 0.001). The physical component score of the 36-item Short Form (SF-36) was increased significantly in HIIT patients (p = 0.02) and borderline increased in CON patients (p = 0.07), whereas there was no significant effect of exercise on the mental component. Depression score decreased significantly in HIIT patients (p = 0.04) with no change in CON patients (p = 0.75), whereas anxiety score decreased significantly in both HIIT (p < 0.01) and CON (p < 0.05) patients. There were no between-group differences in any of the measures (all p > 0.05). Arterial stiffness and biomarkers were not changed, nor did endothelial function change after HIIT (p = 0.08) or CON (p = 0.68). HIIT and CON are both well tolerated and induce similar improvements in physical components of HRQoL and in markers of anxiety. Effects of either training modality on vascular function and biomarkers could not be confirmed.

Parasympathetic reinnervation accompanied by improved post-exercise heart rate recovery and quality of life in heart transplant recipients.

Although sympathetic reinnervation is accompanied by the improvement of exercise tolerability during the first years after heart transplantation (HTx), little is known about parasympathetic reinnervation and its clinical impact. We enrolled 21 recipients (40 ± 16 years, 71% male) who had received successive cardiopulmonary exercise testing at 6 months, and 1 and 2 years after HTx. Exercise parameters such as peak oxygen consumption or achieved maximum load remained unchanged, whereas recovery parameters including heart rate (HR) recovery during 2 minutes and the delay of peak HR, which are influenced by parasympathetic activity, improved significantly during post-HTx 2 years (P < 0.05 for both). HR variability was analysed at post-HTx 6 months in 18 recipients, and high frequency power, representing parasympathetic activity, was significantly associated with the 2 recovery parameters (P < 0.05 for all). We also assessed quality of life using the Minnesota Living with Heart Failure (HF) Questionnaire at post-HTx 6 months and 2 years in the same 18 recipients, and those with improved recovery parameters enjoyed a better HF-specific quality of life (P < 0.05 for both). In conclusion, parasympathetic reinnervation emerges along with improved post-exercise recovery ability of HR and quality of life during post-HTx 2 years.

Psychological Predictors (Personal Recourses) of Quality of Life for Heart Transplant Recipients

BackgroundHeart transplantation (HTx) has a significant impact on all areas of the operation, adjustment, and quality of life (QOL) in patients after heart transplantation. In the process of healing and coping with the new situation, it is important to have personal resources. AimThe main objectives of this study were to assess subjective QOL of patients after HTx and to determine the relationship between personal resources and QOL in this group of patients. Material and MethodsThe study included 121 patients who received a heart transplant. A standardized instrument used to measure the quality of life was the World Health Organization (WHO) QOL Brief Questionnaire. The personal resources and deficits were determined using the following research techniques: Antonovsky's Sense of Coherence (SOC), coping strategies for stress (Brief-COPE), Generalized Self Efficacy Scale (GSES), and Life Orientation Test (LOT-R). The data were analyzed statistically. ResultsThe patients gained an average level of QOL (13.75). The results indicate a positive relationship between the QOL in all its domains and personal resources: a sense of coherence (r = 0.65; P < .05), optimism (r = 0.55; P < .05), self-efficacy (r = 0.58; P < .05), and strategies for coping (active coping [r = 0.41; P < .05], planning [r = 0.42; P < .05; P < .05], and positive revaluing [r = 0.40; P < .05]). The regression model explained 56% of the predictors of QOL in patients after HTx. ApplicationsIt is necessary to strengthen personal resources in this group of patients as well as to detect early and treat symptoms of depression and to cope with stress.

NON-LIPID MECHANISMS OF STATINS ACTION FOR HEART TRANSPLANT RECIPIENTS

Statins are widely used in the treatment of heart transplant recipients. It is assumed that the effectiveness of statins after heart transplantation is due not only to hypolipidemic effects, but also to non-lipid effects, including anti-in fl ammato- ry. In the review are presented the recently published results of the pro-and retrospective studies on the role of statins in the treatment of post-heart transplant recipients. Also there were analyzed the immunomodulatory and anti-in- fl ammatory mechanisms based on reduced levels of C-reactive protein, decreased concentration of cytokines (TNF- α , IL-6, IL-2R), suppression of tissue factor expression by monocytes etc. Another important factor is the role of statins in reducing the risk of cancer for transplant recipients. The use of statins in the treatment with immunosuppressive agents is an important factor in optimizing the long-term outcomes, reduction in the incidence of acute rejection and coronary artery disease of transplanted heart, increasing the duration and quality of life for heart transplant recipients.

Exercise after heart transplantation: An overview

While life expectancy is greatly improved after a heart transplant, survival is still limited, and compared to the general population, the exercise capacity and health-related quality of life of heart transplant recipients are reduced. Increased exercise capacity is associated with a better prognosis. However, although several studies have documented positive effects of exercise after heart transplantation (HTx), little is known about the type, frequency and intensity of exercise that provides the greatest health benefits. Moreover, the long-term effects of exercise on co-morbidities and survival are also unclear. Exercise restrictions apply to patients with a denervated heart, and for decades, it was believed that the transplanted heart remained denervated. This has since been largely disproved, but despite the new knowledge, the exercise restrictions have largely remained, and up-to-date guidelines on exercise prescription after HTx do not exist. High-intensity, interval based aerobic exercise has repeatedly been documented to have superior positive effects and health benefits compared to moderate exercise. This applies to both healthy subjects as well as in several patient groups, such as patients with metabolic syndrome, coronary artery disease or heart failure. However, whether the effects of this type of exercise are also applicable to heart transplant populations has not yet been fully established. The purpose of this article is to give an overview of the current knowledge about the exercise capacity and effect of exercise among heart transplant recipients and to discuss future exercise strategies.

Qualitative interviews vs standardized self-report questionnaires in assessing quality of life in heart transplant recipients

Quality of life (QoL) studies in heart transplant recipients (HTRs) using validated, quantitative, self-report questionnaires have reported poor QoL in approximately 20% of patients. This consecutive mixed methods study compared self-report questionnaires, the Medical Outcomes Study 36-item Short Form Health Survey (MOS SF-36) and the Atkinson Life Satisfaction Scale, with phenomenologically informed audiovisual (AV) qualitative interview data in 27 medically stable HTRs (70% male; age 53 ± 13.77 years; time since transplant 4.06 ± 2.42 years). Self-report questionnaire data reported poor QoL and more distress compared with previous studies and normative population samples; in contrast, 52% of HTRs displayed pervasive distress according to visual methodology. Using qualitative methods to assess QoL yields information that would otherwise remain unobserved by the exclusive use of quantitative QOL questionnaires.

What they say versus what we see: “Hidden” distress and impaired quality of life in heart transplant recipients

Quality of life (QoL) studies in heart transplant recipients generally rely on quantifiable self-report questionnaires and have shown that approximately 20% of patients undergo distress and poor QoL not clearly related to medical variables. Building on existing qualitative research, we used a phenomenologically informed audiovisual method to explore the nature of "distress" in heart transplant recipients. Focused open-ended interviews were conducted in non-clinical settings with 27 medically stable heart transplant recipients (70% male, mean age 53 ± 13 years, range 18 to 72 years; mean time since transplant 4.1 ± 2.4 years). Interviews were audio/videotaped and transcribed verbatim. A qualitative software program (NVIVO8) was used to code interview transcripts and videotaped bodily gestures and "expressive artifacts" as well as vocal tone and volume. Distress was displayed by 88% of patients during the interview, and 52% displayed a profound disjunct between the words they used to describe their quality of life (e.g., "wonderful") and their embodied expressions of the same (e.g., protective body posturing, distressed facial expression). Most also expressed significant distress when discussing issues such as the donor and their "gift of life," as well as a disrupted sense of bodily integrity and identity that they felt could only be appreciated by fellow heart recipients. Increased awareness of this distress and disruption related to bodily integrity and identity after heart transplant may allow transplant professionals and researchers to see beyond "words" to more effectively reduce distress and improve quality of life.

Predictors of quality of life in heart-transplant recipients in Taiwan

Objective This correlational study sought to identify the predictors of quality of life in heart-transplant recipients in Taiwan. Methods One hundred and fifty-three patients were recruited through purposive sampling. Data were collected using 6 questionnaires: (1) a demographic questionnaire, (2) the Transplant Symptom Frequency and Symptom Distress Scale, (3) the Self-Efficacy of Exercise Scale, (4) a compliance questionnaire, (5) the Beck Depression Inventory, Short Form 13, and (6) the Medical Outcomes Short Form 36-Health Survey. Data were analyzed using SPSS, version 17.0 software (SPSS, Inc., Chicago, IL). Data analysis included percentages, means, standard deviations, correlation coefficients, and forward regressions. Results Depression was an independent, and the strongest, predictor of quality of life. Self-perceived health status and self-perceived family support also predicted quality of life. Symptom distress level predicted the physical aspect of quality of life. Conclusions Based on this understanding, an interdisciplinary team can initiate a needs assessment for these heart-transplant recipients, and develop an intervention to meet their needs.

Perceived Health-Related Quality of Life in Heart Transplant Recipients With vs Without Preoperative ECMO in Taiwan: Between-Method Triangulation Study

ObjectiveTo compare changes in overall health-related quality of life (HRQoL), working competence, and physical functions in heart transplant (HTx) recipients with vs without preoperative extracorporeal membrane oxygenation (ECMO) at 3 crucial stages post-HTx: 1 and 6 months and 1 year. Patients and MethodsThis between-method triangulation study included qualitative and quantitative data for patients recruited from a medical center with 2200 beds. Quantitative data were obtained using a vertical visual analog scale and the Taiwan version of the World Health Organization Quality of Life Questionnaire. Six semistructured qualitative questions were added to further explore factors that influence changes in Social domains of HRQoL between the 4 groups across recovery stages. ResultsThe 50 patients (86% men and 14% women) ranged in age from 20 to 70 years (mean age, 47.68 years). Time post-HTx ranged from 1 year to 4 years and 1 month, and 16% had received preoperative ECMO therapy. Mean (SD) HRQoL, working competence, and physical functions improved from 54.76 (24.44), 31.8 (26.53), and 80.00 (33.67), respectively, at 1 month post-HTx (r = .48) to 65.76 (20.24), 50.90 (25.23), and 96.80 (11.05) at 6 months (r = .52) and 74.40 (13.65), 64.30 (21.48), and 98.8 (7.80) at 12 months (r = .44), with moderately significant differences. Compared with the non-ECMO group, the preoperative ECMO group perceived lower (stage 1), similar (stage 2), and higher (stage 3) working competence. Thirty-two percent of recipients resumed stable jobs across the 3 stages (10%, 8%, and 14%, respectively), and reported higher working competence and physical functions compared with other patients (68%) (P < .001). Recipients with stable marriages (P = .046), higher educational achievement level (P = .004), and stable jobs (P = .001) reported greater overall HRQoL across the 3 stages. ConclusionHeart transplant recipients reported higher overall HRQoL, working competence, and physical functions across the 3 recovery stages during 12 months post-HTX. Three major influencing factors identified included stable marriage, higher educational achievement level, and stable job status.

180: What They Say Versus What We See: ‘Hidden' Distress and Impaired Quality of Life in Heart Transplant Recipients

Most studies on Quality of Life (QoL) have relied on quantifiable self report questionnaires. While a large number of studies show improvement in QoL, a subset of at least 20% of heart transplant recipients have documented psychological distress or poor QoL not related to medical variables. Qualitative researchers have begun to investigate this phenomenon drawing on sociological, anthropological and philosophical concepts. Building on existing qualitative work, we used a phenomenologically informed visual method to explore the nature of ‘distress' in heart transplant recipients.