<p>Prevalence and Risk Factors of Immunosuppressant Nonadherence in Heart Transplant Recipients: A Single-Center Cross-Sectional Study</p>

Abstract

BackgroundImmunosuppressant nonadherence (INA) has been shown to affect outcomes after solid organ transplantation. The aim of the present study was to determine the prevalence of INA in heart transplant recipients and the associated risk factors of INA.MethodsAdult heart transplant recipients who firstly received heart transplantation (discharged for at least 3 months) were consecutively enrolled. Immunosuppressant adherence was assessed using the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS). INA was categorized into five domains of contributing factors (socio-demographic factors, transplant-related factors, healthcare system access factors, post-transplant treatment-related factors, and patient-related psychosocial factors). These factors were compared between adherent and nonadherent patients. The risk factors of INA were investigated by logistic regression analysis.ResultsA total of 168 heart recipients were ultimately included. Among them, 69 (41.1%) recipients were revealed to be nonadherent. Logistic regression analysis indicated that INA was associated with monthly income<3000 Chinese Yuan (CNY) (OR, 3.11; 95% CI, 1.58–6.12; p=0.001), number of prescribed concomitant drugs (OR, 1.23; 95% CI, 1.12–1.50; p=0.003) and concerns about immunosuppressants (OR, 1.09; 95% CI, 1.01–1.18; p=0.031).ConclusionsHeart recipients had a high prevalence of INA. Lower income, greater number of prescribed concomitant drugs, and more concerns about immunosuppressants correlated most with timing nonadherence and taking nonadherence among heart recipients. These findings will be helpful to intervene on and prevent future INA of heart recipients.

Implementation of patient‐reported outcome measures in a heart transplant recipient registry: First step toward a patient‐centered approach

“…The BAASIS is reliable, valid, short, simple to use, and sensitive to the taking and timing of immunosuppressive drugs 22 . It has been previously used to evaluate nonadherence to immunosuppressive medication among heart, liver, and lung transplant recipients 23–26 . Its score is reliable, as shown by its total Cronbach alpha coefficient of .697 26 …”

“…22 It has been previously used to evaluate nonadherence to immunosuppressive medication among heart, liver, and lung transplant recipients. [23][24][25][26] Its score is reliable, as shown by its total Cronbach alpha coefficient of .697. 26…”

Describing Predictors Of Regimen Nonadherence Among Kidney Recipients Using Multiple Measures

“…22 Findings based on our calculated nonadherence risk outcome are consistent with other studies that have examined the influence of number of medications on immunosuppressant adherence among kidney and other organ recipients. 20,23 We also found that increased time since transplant was associated with lower risk of immunosuppressant nonadherence; evidence in the literature of the effect of time since transplant is mixed. 19 Differences in adherence based on insurance status were surprising, in that participants in our study with dual private/public coverage were particularly vulnerable to nonadherence risk.…”

“…It is possible that participants in our sample who struggled with a greater number of comorbid conditions found taking related medications more burdensome, which has been observed to affect adherence among other organ recipients. 20 This might extend to depression as well; there is some evidence that higher levels of depression are linked with a greater number of comorbid conditions. 21 Health literacy was also significantly related to poorer regimen adherence in our study, and as a modifiable SDOH, this may be informative for intervention.…”

Efficacy of Adherence-Enhancing Interventions for Immunosuppressive Therapy in Solid Organ Transplant Recipients: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials

“…Nonadherence can be either deliberate or unintentional and include such events as not taking the medication as often as required, not in the exact dose and/or at the correct times (O'Carroll et al, 2006). The prevalence of immunosuppressant non-adherence can vary from 2 to 67% in solid organ transplant recipients (Martin and Gabardi, 2009;Zhang et al, 2019). The highest rate of immunosuppressant non-adherence was found in kidney transplant recipients with a prevalence of 36-55% (Gokoel et al, 2020), while that in adult heart transplant recipients is 34.1-41.1% (Leven et al, 2017) and 15-40% in liver transplants (Zhang et al, 2019).…”