Psychosocial and behavioural factors in heart transplant candidates – an overview

Abstract

Mortality among heart transplant (HTX) candidates remains high. This review of the literature shows that psychosocial characteristics like depression, social isolation and coping strategies contribute to morbidity and mortality in heart failure (HF) patients, and may also be relevant to the prognosis of HTX candidates. Based on the research to date, physical activity favourably affects subjective and objective parameters not only in HF patients, but also in HTX candidates. Depression is prevalent among HTX candidates, especially in ischaemic patients, and seems to be related to earlier transplantation. Findings on the effects of depression on pretransplant mortality are conflicting. Not much is known concerning social isolation, coping, nutrition, or weight loss in this patient group. Identification of modifiable psychosocial and behavioural variables related to clinical status in this patient group is clearly needed and will aid the development of behavioural interventions to supplement medical therapies.

Supportive psychotherapy for patients with heart transplantation or ventricular assist devices☆☆☆

“…Our data suggest further that patients on VAD support experience psychosocial and emotional stress as severe as Social support by significant others has been identified as a key element for positive outcome of HTX and VAD support, and perceiving social support is one of the most positive coping strategies [11,14]. Moreover, coping by their families and significant others can influence the patients' coping in positive or negative ways [15].…”

“…Anxiety of not surviving the waiting period and impairments of psychosocial functioning increase with time [10]. Whereas HTX candidates benefit from physical activity [11], VAD patients are greatly limited in this regard.…”

“…During the waiting period, avoidant coping strategies in HTX candidates have been identified as an adverse factor for outcome [11]. Likewise, VAD patients are typically compromised by using strategies of regressive retreat, trivialization, and wishful thinking [9].…”

The role of the Heart Failure Survival Score and psychosocial stress in predicting event-free survival in patients referred for heart transplantation

“…2 Overall, these findings indicate that not only medical risk but also psychosocial stress contribute to event-free survival in patients listed for cardiac transplantation, a result that is in line with the literature on psychosocial stress in heart failure. 5 Thus, not only patients entering the waiting list with high medical risk, but also those with high psychosocial stress are in utmost need of professional attention. Unfortunately, in our study, only 35% of the patients with high psychosocial stress reported that they received any psychological counseling.…”

Nutritional Intervention in Heart Transplant Recipients – Dietary Recommendations

“…The scientific literature shows different mood disorders in both the situation prior to transplantation and thereafter; the most common that have been tested are the anxiety disorders, depression and post traumatic stress disorder (Perez San Gregorio et al, 2005;Spaderna et al, 2007) and they have been found to adversely affect the ability to accept the new organ.…”