It's not the bad guys. A differentiated view on post HTX adherence: Medication, mental health, hygienic behavior

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.