Mary McLeod

Emotional adjustment 5 years after heart transplant: A multisite study

Objective: To assess levels of and factors associated with depression and negative affect 5 years after heart transplant (HT). Participants: 370 adults 5 years post-HT. Outcome Measures: Cardiac Depression Scale and the Positive and Negative Affect Schedule (PANAS). Research Method: Stepwise multiple regression analyses were used to test 32 potential demographic, medical, functional, and psychosocial factors in adjustment. Results: Predictor variables accounted for 53% of the variance of depression scores and 45% of the variance of PANAS negative affect scores. The best predictors (p .001) for depression were neurological symptoms, younger age, lower recreational functioning, and lower satisfaction with emotional support, and the best predictors for negative affect were neurological symptoms, lower mobility functioning, and perceived uncertainty about health. Depression scores were lower than norms for nontransplanted heart failure patients, and negative affect levels were comparable to those of the general population. Conclusions: The findings indicate normal long-term adjustment among HT recipients. Several factors associated with negative emotions, including younger age, have not been identified in previous research.

Is outcome after heart transplantation influenced by ethnicity? A comparison of African Americans versus Caucasians.

transplantation increases the risk of postoperative complications. The purpose of our current study was to test this hypothesis by evaluating 50 patients who were transplanted at our facility over the past six years. Seventeen (34%) of these patients had received amiodarone prior to transplantation while the remaining thirtythree (64%)had not. Endpoints of the study included: length of hospital stay, survival to hospital discharge, 30 day mortality, 6 month mortality, 1 year mortality, number of days ventilated, ARDS, hepatic failure, number of days paced, need for permanent pacemaker, refractory hypotension, and bleeding complications. There were no significant differences between the two groups in age, sex, etiology of heart failure, LVEF, preoperative platelet or INR values. Patients in the amiodarone group, however, were more likely to be on an assist device or IABP prior to transplantation compared to the non-amiodarone group (47% vs 12%, p50.005). There were no significant differences between the amiodarone and non-amiodarone groups in length of stay (21 vs 17 days, p50.72), 6 month mortality (29% vs 15%, p50.19), 1 year mortality (27% vs 18%, p50.5), days ventilated (8 vs 6, p50.7), ARDS (6% vs 0, p50.16), hepatic failure (18% vs 9%, p50.4), days paced (2 vs 2, p50.67), need for permanent pacemaker (0 vs 3%, p50.47), or refractory hypotension (18% vs 9%, p50.4). Amiodarone patients were less likely to survive to hospital disharge (71% vs 94%, p50.02) and a trend was seen for 30 day mortality (18% vs 3%, p50.07). They were also more likely to experience a bleeding complication (41% vs 9%, p50.007), even when patients on mechanical assist devices were excluded (33% vs 7%, p50.04). In conclusion, amiodarone patients were not at increased risk of ARDS, bradycardia, hepatic failure, or refractory hypotension. Amiodarone patients did experience more bleeding complications in the postoperative period. This finding has important clinical implications for many cardiac transplantation patients and warrants further investigation.