Liver Transplant Recipient, Caregiver, and Provider Perceptions of Cardiovascular Disease and Related Risk Factors After Transplant

Abstract

Liver transplant recipients (LTRs) are at high risk for cardiovascular disease (CVD). We sought to characterize LTR, informal caregiver, and health care provider perceptions about CVD care after liver transplantation (LT) to inform the design of solutions to improve care. Participants included adult LTRs, their caregivers, and multispecialty health care providers recruited from an urban tertiary care network who participated in 90-minute focus groups and completed a brief survey. Focus group transcripts were analyzed using thematic analysis, and survey data were analyzed using descriptive statistics. A total of 17 LTRs, 9 caregivers, and 22 providers participated in 7 separate focus groups. Most (93.3%) LTRs and caregivers were unaware of the risk of CVD after LT. Although 54.5% of providers were confident discussing CVD risk factors with LTRs, only 36.3% were confident managing CVD risk factors in LTRs, and only 13.6% felt that CVD risk factors in their LTR patients were well controlled. Barriers to CVD care for LTRs included (1) lack of awareness of CVD risk after LT, (2) lack of confidence in an ability to provide proper CVD care to LTRs, (3) reluctance to provide CVD care without transplant provider review, and (4) complexity of communication with the multidisciplinary LTR care team about CVD care. Participant recommendations included improved education for LTRs and caregivers about CVD risk factors, electronic health record alerts for providers, clearly defined CVD care provider roles, increased use of the transplant pharmacist, and multidisciplinary provider meetings to discuss care plans for LTRs. Multiple barriers to CVD care after LT were identified, and targeted recommendations were proposed by participants. Transplant centers should integrate participants' recommendations when designing interventions to optimize CVD care for LTRs.

Results of a multidisciplinary strategy to improve the management of cardiovascular risk factors after liver transplantation

“…Although several barriers in the application of better CV care to LT recipients have been identified, [ 14 ] efforts to overcome these barriers are also being made. Among these, the Northwestern Method © is a mixed‐methods approach that consists in adaptation of practice guidelines by a multidisciplinary panel of experts, identification of barriers for guidance adherence, and implementation and dissemination of the guidance.…”

“…[13] Recent studies have identified several barriers to provide better CV care of LT recipients, such as lack of awareness of CV risk (CVR), lack of confidence to provide high-quality CV care to LT recipients, or difficulties in establishing multidisciplinary teams. [14] Considering all this, we designed a multidisciplinary protocol with the aim of improving the identification and control of post-LT metabolic comorbidities. Here, we report our experience with the first 150 patients included in the protocol and compare their clinical risk profiles at baseline and 12 months after LT with those of a cohort of 100 patients who underwent LT before the inception of the protocol.…”

Comanagement With Nephrologist Care Is Associated With Fewer Cardiovascular Events Among Liver Transplant Recipients With Chronic Kidney Disease

“…Recent work by our group identified several barriers to providing multidisciplinary CV disease prevention care to LTRs, including (1) lack of awareness of CV disease risk after LT, (2) lack of confidence in an ability to provide proper CV disease care to LTRs, (3) reluctance to provide CVD care without transplant provider review, and (4) complexity of communication with the multidisciplinary LTRs care team about CVD care. 24 These identified barriers provide potential targets for quality improvement initiatives to improve comanagement of prevalent CV disease risk factors, such as CKD, among LTRs.…”

Management of cardiac diseases in liver transplant recipients: Comprehensive review and multidisciplinary practice-based recommendations

“…However, the optimal method and frequency of testing and treatment remain uncertain. Multiple barriers exist to implement primary and secondary prevention of CHD once identified, including lack of confidence of providers and the complexity of post‐LT care 26 . Table 3 summarizes our practice‐based recommendations for prevention and management of CHD in LTRs.…”