Psychological distress of surgical patients after orthotopic heart transplantation

Factors associated with stress and coping at 5 and 10 years after heart transplantation

BACKGROUND

Heart transplant-related stressors and coping are related to poor outcomes early after transplant. The purposes of our study were to (1) identify the most frequent and bothersome stressors and most used and effective coping strategies and (2) compare the most frequent and bothersome stresses and most used and effective coping styles between patients at 5 and 10 years after heart transplantation. We also examined differences in coping styles by patient characteristics and factors associated with frequency and intensity of stress at 5 and 10 years after heart transplantation.

METHODS

This report is a secondary analysis of data from a prospective, multisite study of quality of life outcomes. Data are from separate cohorts of 199 patients at 5 years after transplant and 98 patients at 10 years. Patients completed the Heart Transplant Stressor Scale and Jalowiec Coping Scale. Statistical analyses included frequencies, measures of central tendency, t-tests, chi-square, and generalized linear models.

RESULTS

At 5 and 10 years after heart transplantation, the most bothersome stressors were regarding work, school, and financial issues. Patients who were 10 years after transplant reported less stress, similar stress intensity, and less use and perceived effectiveness of negative coping than patients who were 5 years after transplant. Long-term after transplant, demographic characteristics, psychologic problems, negative coping, and clinical factors were related to stress frequency and/or intensity.

CONCLUSIONS

Heart transplant-related stress occurs long-term after surgery. Types of transplant-related stress and factors related to stress confirm the importance of ongoing psychologic and clinical support after heart transplantation.

The relationship between depressive symptoms and anxiety and quality of life and functional capacity in heart transplant patients

OBJECTIVE

To establish the relationship between depressive symptoms and anxiety with both the quality of life and functional capacity of heart transplant patients.

METHODS

Thirty-four patients were included. Outcome measures were the Beck Depression Inventory (BDI), the State- Trait Anxiety Inventory (STAI), the Short Form 36 (SF36) and peak oxygen consumption (pVO2).

RESULTS

After the transplant there was a significant negative correlation between the BDI and most of subgroups on the SF36 (p<0.05). There were significant negative correlations found between the pVO2 and both the BDI and STAI-trait anxiety score (p<0.05). Statistically significant improvements were noted in all subgroups on the SF36 and all BDI scores after the transplant, in comparison to the pre-transplant period (p<0.05).

CONCLUSIONS

The functional capacity of a person affects the state of their depression and anxiety. We recommend participation in a cardiac rehabilitation program in the early stages of transplantation and believe that the quality of life, which has been shown to be related to the functional capacity and psychological symptoms, would benefit from this program.