Changes of mental and physical components of quality of life in patients after heart transplantation: experience of the Almazov National Medical Research Center

Abstract

Aim. To assess the changes of quality of life (QoL) in patients after heart transplantation (HTx) and identifying factors associated with its changes.Material and methods. We retrospectively assessed the register created on the basis of the original database "Mental status of patients after heart transplantation: experience of the Almazov National Medical Research Center" № 2023622138. There were following inclusion criteria: recipients aged over 18 years with preserved cardiac transplant function (Simpson's left ventricular ejection fraction >55%) with a follow-up period >3 months after transplantation. After inclusion on the heart transplant waiting list, patients filled out the SF-36 questionnaire and a coping test, while then 3-6 months, 1 and 3 years after HTx — SF-36, a coping test and the International Physical Activity Questionnaire (IPAQ).Results. The mean age of recipients included in the study (n=112; 84 men) was 48±11-year-old. According to the SF-36 results after HTx, patients improved most of the indicators of physical QoL, except for Bodily Pain (BP), while the level of mental QoL increased by 3-6 months after surgery and did not undergo significant changes thereafter. According to the Lazarus coping test, during the 1st year after HTx the level of coping mechanisms did not change, but by 3 years after the surgery there was a positive trend in the form of a gradual decrease. In the first 3-6 months after HTx, one third of the patients were physically active, the rest led a sedentary lifestyle. After HTx, the number of physically active recipients increased, and after 3 years they accounted for only half of the observed patients. According to the SF-36 and the coping test, the following components of QoL (BP, role-functioning physical, role-functioning emotional, vitality) and self-control were higher in physically active recipients. Other indicators did not change depending on physical activity (PA; p>0,05). There were no differences in SF-36, Lazarus test and IPAQ scores depending on whether patients worked after HTx or not. After HTx, there were no significant correlations between QoL indicators and recipients' sex, length of stay in the HTx waiting list and in the ICU after HTx, or the use of mechanical circulatory support prior to HTx.Conclusion. After HTx, physical QoL improved, remaining at a stable level during 3 years follow-up, and its positive changes were directly related to the PA of patients. Older age and lack of PA negatively affected post-transplant QoL. Compared with the results during stay in the HTx waiting list, 3-6 months after HTx, mental QoL improved and remained stable at 3 years after surgery, which was associated with the clinical condition of the patients and the normal functioning of the heart transplant. At the same time, the main factors that positively affected its dynamics were male sex, a sedentary lifestyle, as well as a lower level of the coping mechanism of escape-avoidance of the problem and a higher level of self-control.