1
|
Oehler D, Bruno RR, Kelm M, Lichtenberg A, Boeken U, Westenfeld R. COVID-19 pandemic deteriorates aftercare attendance in heart transplant recipients independently of perceived impact on social life. Transpl Infect Dis 2022; 24:e13844. [PMID: 35505522 PMCID: PMC9347611 DOI: 10.1111/tid.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Heart transplant (HTx) recipients are at an increased risk of developing infections or malignancies due to immunosuppressive medication. Thus, regular aftercare in those patients is of utmost importance. The extent of collateral damage due to the COVID-19 pandemic (delayed or canceled clinical visits and diagnostics) on high-risk patients is yet unknown. We believe that, especially for HTx-patients, data acquisition on potential pandemic-related nonattendance is crucial to improve clinical care in the future. Therefore, we aim to decipher possible COVID-19-related alterations in attendance to clinical care after HTx using a survey-based approach. METHODS HTx recipients, 2 years beyond transplantation were selected (n = 75). We filed a paper-based questionnaire or an online survey containing nine items about COVID-19-related exceptional circumstances. Fifty-two patients (69%) returned fully answered questionnaires. RESULTS A perceived impact on daily life was evident with 79% of all patients, reporting a moderate-to-severe negative influence of the COVID-19 pandemic on daily routine. We detected increased nonattendance of clinical care during the COVID-19 pandemic compared to prepandemic time (38 vs. 6%, p < .0001). The various diagnostic modalities of aftercare were heterogeneously affected, ranging from 2% nonattendance for influence vaccination and 18% for colonoscopy. Off note, nonattendance to clinical care within the pandemic was independent of perceived impact of the pandemia on daily life (p > .68). CONCLUSIONS For the first time, we objectively demonstrate a significant decrease in attendance to clinical care in HTx recipients during the COVID-19 pandemic. Efforts are needed to increase attendance in this highly vulnerable patient cohort.
Collapse
Affiliation(s)
- Daniel Oehler
- Division of CardiologyPulmonology, and Vascular Medicine Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany,Cardiovascular Research Institute DüsseldorfMedical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Raphael Romano Bruno
- Division of CardiologyPulmonology, and Vascular Medicine Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany,Cardiovascular Research Institute DüsseldorfMedical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Malte Kelm
- Division of CardiologyPulmonology, and Vascular Medicine Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany,Cardiovascular Research Institute DüsseldorfMedical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Artur Lichtenberg
- Department of Cardiovascular SurgeryMedical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Udo Boeken
- Department of Cardiovascular SurgeryMedical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Ralf Westenfeld
- Division of CardiologyPulmonology, and Vascular Medicine Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany,Cardiovascular Research Institute DüsseldorfMedical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| |
Collapse
|
2
|
Gomis-Pastor M, Mirabet Perez S, Roig Minguell E, Brossa Loidi V, Lopez Lopez L, Ros Abarca S, Galvez Tugas E, Mas-Malagarriga N, Mangues Bafalluy MA. Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial. Healthcare (Basel) 2021; 9:healthcare9040463. [PMID: 33919899 PMCID: PMC8070926 DOI: 10.3390/healthcare9040463] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.
Collapse
Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, 08025 Barcelona, Catalonia, Spain
- Correspondence: ; Tel.: +34-667411996
| | - Sonia Mirabet Perez
- Cardiology Department, Hospital de la Santa Creu i Santa Pau and CIBER de Enfermedades Cardiovasculares (CIBER-CV), 08041 Barcelona, Catalonia, Spain;
| | - Eulalia Roig Minguell
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Vicenç Brossa Loidi
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Laura Lopez Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Sandra Ros Abarca
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Elisabeth Galvez Tugas
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Núria Mas-Malagarriga
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau, 08025 Barcelona, Catalonia, Spain;
| | - Mª Antonia Mangues Bafalluy
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau and CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 08025 Barcelona, Catalonia, Spain;
| |
Collapse
|
3
|
Gomis-Pastor M, Roig E, Mirabet S, T De Pourcq J, Conejo I, Feliu A, Brossa V, Lopez L, Ferrero-Gregori A, Barata A, Mangues MA. A Mobile App (mHeart) to Detect Medication Nonadherence in the Heart Transplant Population: Validation Study. JMIR Mhealth Uhealth 2020; 8:e15957. [PMID: 32014839 PMCID: PMC7055830 DOI: 10.2196/15957] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 01/17/2023] Open
Abstract
Background Medication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population. Objective The study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research. Methods A prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1.5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study. Results We included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0.6, P<.001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0.3, P=.12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0.7, P<.001). Reproducibility was moderate (Haynes-Sackett κ=0.6, P<.002) or poor (Morisky-Green-Levine κ=0.3, P=.11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P<.05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR. Conclusions ePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.
Collapse
Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Eulalia Roig
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.,Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Sonia Mirabet
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Jan T De Pourcq
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Irene Conejo
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Vicens Brossa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Laura Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Andreu Ferrero-Gregori
- Institute of Biomedical Research IIB Sant Pau, Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Anna Barata
- Moffitt Cancer Center, Florida, FL, United States
| | - M Antonia Mangues
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| |
Collapse
|
4
|
Brocks Y, Zittermann A, Grisse D, Schmid-Ott G, Stock-Gießendanner S, Schulz U, Brakhage J, Benkler A, Gummert J, Tigges-Limmer K. Adherence of Heart Transplant Recipients to Prescribed Medication and Recommended Lifestyle Habits. Prog Transplant 2017; 27:160-166. [PMID: 28617170 DOI: 10.1177/1526924817699959] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Nonadherence may cause severe health problems in heart transplant (HTx) recipients. RESEARCH QUESTIONS The present study aimed to investigate adherence to prescribed medication and recommended lifestyle habits in post-HTx patients and to assess associations between adherence, quality of life (QOL), and psychological well-being. DESIGN A questionnaire package was sent to all HTx patients from our clinic (n = 858) to answer questions anonymously on medication adherence, dietary recommendations (avoidance of raw animal products and ice cream), pet keeping (risk of zoonosis), anxiety and depression, QOL, and posttraumatic stress disorders. RESULTS Of the contacted patients, 524 (61%) responded and 505 fulfilled the inclusion criteria (age ≥18 years and ability to understand German). Of the study participants, 72.4% reported taking their medications very correctly, 72.2% stated consuming alcohol less often than once a week, 58.3% performed physical exercise at least once a week, one-third reported eating nonrecommended foods, 22.1% stated pet keeping, and 4.3% reported smoking. Adherence to prescribed medication was positively associated with age ( P < .001) and mental QOL ( P = .015) but was unrelated to eating nonrecommended foods ( P > .05). Depressiveness correlated inversely with physical QOL ( r = -0.232; P < .01) and mental QOL ( r = -0.411; P < .01). Stress disorders and minor stressful events were reported by 7.8% and 46.6%, respectively. Stress disorders correlated inversely with mental QOL ( r = -0.282; P < .01) and physical QOL ( r = -0.422; P < .01). DISCUSSION Many HTx patients adhere to prescribed medications and health advice. Nevertheless, nonadherence is a problem, especially in younger HTx patients, indicating the need for a nonadherence crisis intervention program for long-term HTx patients.
Collapse
Affiliation(s)
- Y Brocks
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - A Zittermann
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - D Grisse
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | | | | | - U Schulz
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - J Brakhage
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | | | - J Gummert
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Katharina Tigges-Limmer
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|