- Email: [email protected]
A community-based weight management program for cardiac transplant recipients: results of a pilot study
S130
Abstracts
The Journal of Heart and Lung Transplantation January 2003
tended to be higher in the ⬎65 year old group (51.7⫾7.9 vs 60.1⫾4.2; p⫽0.06). There was no difference in immunosuppressive medications between groups. Conclusion: General QOL is normal during the first year post OHT, despite the frequent visits and invasive procedures. In carefully selected OHT recipients, the older than 65 year old group had similar normal general QOL as the younger recipient group.
173 RESOURSE IMPLICATIONS OF ECMO AS A BRIDGE TO PAEDIATRIC HEART TRANSPLANT P. Whitmore, S. Nelligan, A. Goldman, M.E. Jones, M. Burch, Cardiothoracic Services (CRACC), Great Ormond Street Hospital for Children, London, England, United Kingdom Bridging children to heart transplantation remains difficult because of unsuitability of many adult VADs. Since 2000, we have adopted a policy of using ECMO. To date, we have bridged 8 children to transplant, all of whom have survived, but have had complicated post-operative courses, which has resource implications for the multidisciplinary team looking after them. Tracheostomy was performed on 5 children post transplant. All patients had marked muscle weakness requiring a prolonged period of rehabilitation physiotherapy. The median time from surgery to walking unaided was 12 days (range 4-34 days). The psychological impact of ECMO and transplantation on these children was manifest in a variety of modes: depression, anxiety, delusions, nightmares and denial. All of these children required significantly more input from the multidisciplinary team than children who had undergone transplant without being bridged on ECMO. The rehabilitation course centred around physiotherapy, psychology, nutrition, medical and nursing expertise, as well as parental input, for these children to improve their quality of life. To date, all of these children have returned to school and are NYHA class 1. Although physically rehabilitated, psychological input and assessments continued. In conclusion, ECMO as a bridge to paediatric heart transplant has a low mortality. Morbidity is high and adequate resources need to be allocated for a multidisciplinary team to help these children return to a normal life. Patient details and duration of stay in each area in days Sex
Age
Weight in Kg
Diagnosis
Days ECMO
ITU Post op
HDU Post op
LDA Post op
F F M F F F M F
11 12 16 15 14 9 4 11
31.6 44.0 35.0 60.0 36.0 27.0 17.0 40.0
MV surgery MV surgery Cardiomyopathy Cardiomyopathy Cardiomyopathy Cardiomyopathy Cardiomyopathy Cardiomyopathy
7 DAYS 11 8 2 6 14 11 12
7 53 22 7 22 18 26 23
3 16 15 19 16 8 8 8
10 15 4 30 30 5 3 21
Age ⫽ years, LDA ⫽ low dependency area.
174 ASPECTS OF ADHERENCE TO THE TREATMENT REGIMEN FOLLOWING HEART OR HEART-LUNG TRANSPLANTATION IN YOUNG PEOPLE J.C. Wray,1 S. Waters,2 T. Sensky,2 R.C. Radley-Smith,1 1PSU, Harefield Hospital, Harefield, Middlesex, United Kingdom; 2Imperial College School of Medicine, London, United Kingdom
Non-adherence to medical treatment has emerged as a significant problem in transplantation (tx) and has particularly been associated with adolescence. There is little research on the risk factors for non-adherence in heart and heart-lung transplant patients but it has been suggested that up to a third of patients are non-adherent to some aspects of the treatment regimen. Fifty adolescents and young adults (24 males, 26 females; mean age: 17.9 years, range 12.3-24.9 years) who had undergone heart (n⫽42) or heart-lung (n⫽8) tx 1.4-14.9 years (mean 8.8 years) previously were asked to complete the Beliefs about Medication Questionnaire (BMQ), Perceived Illness Experience (PIE) scale and a demographics questionnaire. The notes of all patients were reviewed for information regarding previous psychiatric referral, rejection episodes and complications and noted concerns about adherence. Forty completed questionnaires were received and in 11 (28%) non-adherence to treatment was reported. It was also documented in the clinical notes of 9 (18%) of the patients. Non-adherence recorded in the notes was classified as intentional non-adherence and was correlated with lack of exercise (p⫽.032), psychiatric referral (p⫽.009) and lymphoma (p⫽.009). Non-adherence determined from the questionnaires was classified as unintentional and related to forgetting to take medication. Unintentional non-adherence was correlated with high scores on the preoccupation with illness (p⫽.041) and difficulties at school (p⫽.009) subscales of the PIE. In conclusion, more than a quarter of the sample demonstrated non-adherence to the treatment regimen. In contrast to previous research, we found that unintentional non-adherence is associated with different factors to intentional non-adherence. Future research is required to determine whether unintentional non-adherence results in significant medical complications in the longer term and how a reduction in the prevalence of non-adherence can be facilitated. 175 A COMMUNITY-BASED WEIGHT MANAGEMENT PROGRAM FOR CARDIAC TRANSPLANT RECIPIENTS: RESULTS OF A PILOT STUDY J.J. Salyer,1 M.P. Flattery,2 P.L. Joyner,3 R.K. Elswick,4 1Adult Health Nursing, Virginia Commonwealth University School of Nursing, Richmond, VA; 2Cardiothoracic Nursing, Medical College of Virginia Hospitals of Virginia Commonwealth University, Richmond, VA; 3 Nursing, McGuire Veterans Administration Medical Center, Richmond, VA; 4Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA Purpose: After cardiac transplant (tx), obesity, dyslipidemia, and hypertension are common and thought to be related to triple-drug immunosuppression and poor adherence to diet and exercise prescriptions. A lifestyle intervention that allows recipients to attend a community-based weight management program may improve health outcomes. The purpose of this study is to determine: (1) the effects of attending a community-based weight management program on weight loss, SBP, DBP, and lipid profile, and (2) the feasibility and acceptability of using a community-based program for weight management. Procedure: 21 patients (81% male; age⫽57; 99.7 mo. post-tx; 139% of IBW) participated in a randomized clinical trial and recieved either weight loss counselling from a registered dietician (usual care) or a 6-mo. Weight Watchers (WW) scholarship (treatment). Results: At baseline, there were no differences between groups in demographics. There were also no differences in outcome variables except weight (control ⫽ 102.1 Kg vs. treatment ⫽ 98.3 Kg; p⫽.047). Using a simple ANCOVA model with baseline values serving as covariates, group differences in outcomes were assessed and are
The Journal of Heart and Lung Transplantation Volume 22, Number 1S reported as adjusted means. After 6 months, significant changes were found in weight (control⫽100.5 Kg; treatment⫽95.6 Kg; p⫽.047) and HDL (control ⫽40.6mg/dl; treatment⫽49.1mg/dl; p⫽.044). A marginally significant difference was found in SBP (control⫽138mmHg; treatment⫽121mmHg; p⫽.07). A clinically significant decrease in DBP (6 mmHg) was noted which was attributed to treatment effect (p⫽.16). No differences were noted in cholesterol, triglycerides, or LDL. WW participants (n⫽10) attended an average of 24 of 26 meetings; 100% rated the program as acceptable. Meeting locations/times were rated as convenient. Group discussion was considered beneficial in managing weight loss. Conclusions: The WW Program appears to be an effective, feasible, & acceptable alternative to usual care.
176 LVAD DRIVELINE INFECTIONS IN THE MODERN ERA : INCIDENCE RISK FACTORS AND STRATEGIES FOR REDUCTION E.A. Stanford, L.J. Carozza, S. Winowich, J.S. Sapirstein, L.L. Shears, R.L. Kormos, Department of Surgery, University of Pittsburgh, Pittsburgh, PA Since 1998, 84 patients have received a ventricular assist device (VAD) as a bridge to cardiac transplantation (TRX) in a single center. Purpose: To examine factors predisposing to VAD driveline infection (DI) during two eras (1998-1999⫽I, 2000-2002⫽II) of implantation during which time driveline management protocols were altered in frequency and methodology. Methods: Patient data was collected prospectively into a database and analyzed for frequency and risk factors associated with DI. Data: There were 22 LVAD⬘s and 15 BiVAD⬘S in Era I and 20 LVAD⬘s and 27 BiVAD⬘s in Era II. There were no differences between patients in Era I vs. II based upon etiology or acuteness of onset of severe CHF, nor between gender, age, and size, pre-implant length of hospital stay or pre-implant hemodynamics or renal or hepatic function. Overall length of VAD support was longer in Era I vs II (168 vs 81days, p⬍0.01). Actuarial freedom from DI at 6 months in Era I patients was 24% compared to 70 % in Era II. DI⬘s were present in 59% of LVAD⬘s and 60% of BiVAD⬘s in Era I and in 10% of LVAD⬘s and 18% of BiVAD⬘s in Era II. Patients in Era I who developed DI⬘s had longer support times than those in Era II (235 vs. 68 days, p⬍0.01), and more frequent reoperations (43% vs. 78%, p⬍0.05). Patients in Era II who developed Di⬘s had a higher peak creatinine pre-implant than era II patients ( 4.2 vs. 2.2, p⬍ 0.01), and a lower pre-implant hemoglobin ( 9.6 vs. 11.2, p⬍0.02). In addition, there were more patient with post-implant renal failure in Era II patients with DI ( 60% vs. 12%, p⬍0.04). In addition, blood stream infection was seen in 16% of patients without DI vs. 55% of those with DI regardless of Era. Conclusion: Although DI⬘s have been significantly reduced in both LVAD⬘s and BiVAD⬘s due to changes in management strategies, patients with renal dysfunction are still at risk of DI which increases the risk of bacteremia.
177 ADHERENCE TO SELF-MONITORING PROTOCOLS AFTER LUNG TRANSPLANT J.B. Rea,1 C.M. Lawrence,1 J.W. Curl,1 K.G. Setliff,1 R.D. Davis,2 S.M. Palmer,3 1Advanced Practice Nursing, Duke University Health System, Durham, NC; 2Cardiothoracic Surgery, Duke University Health System, Durham, NC; 3Pulmonary and Critical Care Medicine, Duke University Health System, Durham, NC
Abstracts
S131
Purpose: Early detection of abnormalities in pulmonary function after lung transplant may lead to more effective therapeutic interventions. Patients at our institution are therefore instructed to monitor their FVC and FEV1 daily and report declines of 10% or more. Anecdotal experience indicates that many patients do not adhere to this recomendation despite repeated instruction. This single center, prospective, observational study was designed to describe patient adherence to self-monitoring protocols after lung transplant. Procedures: Patients were given a Likert scale questionnaire addressing self-monitoring frequency of spirometry, blood pressure, temperature, weight, and blood work. Questionnaires were handed to 119 randomly selected adult lung transplant recipients who had at least one year of post-transplant follow-up during clinic appointments, 54 questionnaires were returned. Summary: Of the respondents, 23 (44%) monitored spirometry daily, 22 (42%) monitored blood pressure daily, 19 (37%) monitored temperature daily, 28 (54%) monitored weight daily, and 23 (44%) monitored monthly blood work. Only 9 (17%) reported following all recommended frequencies of self-monitoring. No significant differences were found between those adherent and non-adherent to daily spirometry self-monitoring with respect to age, sex, race, or preoperative diagnosis. Patients who received bilateral lung transplants reported superior adherence to self-monitoring (p⫽0.04). Additionally, there was a trend toward decreasing adherence with increasing time elapsed since transplant (p⫽0.10). Conclusion: Despite instruction about the importance of self-monitoring for early detection and intervention, most patients do not adhere to self-monitoring protocols. Patients become more complacent about self-monitoring over time. The differences observed between single and bilateral lung transplant recipients warrant further study. Additional interventions to improve adherence to self-monitoring should be devised, tested, and implemented. 178 WHAT CONTRIBUTES TO EMOTIONAL DISTRESS IN FEMALE HEART TRANSPLANT RECIPIENTS? I. Gerard,1 L.V. Doering,1 L. Evangelista,1 K. Dracup,2 J. Kobashigawa,3 1School of Nursing, University of California Los Angeles, Los Angeles, CA; 2School of Nursing, University of California San Francisco, San Francisco, CA; 3School of Medicine, University of California Los Angeles, Los Angeles, CA Emotional distress after heart transplant (HT) is associated with higher incidence of rejection and increased morbidity. Although depression and anxiety are more prevalent in women with other cardiac conditions, their level of emotional distress following HT is unknown. This study’s purpose was to describe the prevalence of dysphoria in female HT recipients and explore associated variables. Methods: Fifty female HT recipients (age 54.7⫾13.0 years, time from transplant 5.1⫾4.4 years, 69% Caucasian, 64% ischemic heart failure (HF) etiology, 92% receiving triple immunosuppressive regimen (ISR) were enrolled during a routine clinic visit and completed the Multiple Affect Adjective Checklist. Demographic and clinical variables were identified by chart abstract. Rejection rate was defined as the proportion of endomyocardial biopsies graded 1 - 3 (any rejection). Data were analyzed using univariate correlations and multiple linear regression. Results: Eighty percent reported symptoms above normative values for at least 1 of 3 dysphoric states (depression, anxiety, or hostility). Seventy-two percent reported ⱖ2 dysphoric states. Symptoms were not correlated with age, marital status, time since transplant, LVEF, or comorbidities. HF etiology, ISR, and rejection history accounted for 30.0% (p⫽.001), 29.4% (p⬍.000), and 26.7% (p⬍.004) of the variance
Abstracts
The Journal of Heart and Lung Transplantation January 2003
tended to be higher in the ⬎65 year old group (51.7⫾7.9 vs 60.1⫾4.2; p⫽0.06). There was no difference in immunosuppressive medications between groups. Conclusion: General QOL is normal during the first year post OHT, despite the frequent visits and invasive procedures. In carefully selected OHT recipients, the older than 65 year old group had similar normal general QOL as the younger recipient group.
173 RESOURSE IMPLICATIONS OF ECMO AS A BRIDGE TO PAEDIATRIC HEART TRANSPLANT P. Whitmore, S. Nelligan, A. Goldman, M.E. Jones, M. Burch, Cardiothoracic Services (CRACC), Great Ormond Street Hospital for Children, London, England, United Kingdom Bridging children to heart transplantation remains difficult because of unsuitability of many adult VADs. Since 2000, we have adopted a policy of using ECMO. To date, we have bridged 8 children to transplant, all of whom have survived, but have had complicated post-operative courses, which has resource implications for the multidisciplinary team looking after them. Tracheostomy was performed on 5 children post transplant. All patients had marked muscle weakness requiring a prolonged period of rehabilitation physiotherapy. The median time from surgery to walking unaided was 12 days (range 4-34 days). The psychological impact of ECMO and transplantation on these children was manifest in a variety of modes: depression, anxiety, delusions, nightmares and denial. All of these children required significantly more input from the multidisciplinary team than children who had undergone transplant without being bridged on ECMO. The rehabilitation course centred around physiotherapy, psychology, nutrition, medical and nursing expertise, as well as parental input, for these children to improve their quality of life. To date, all of these children have returned to school and are NYHA class 1. Although physically rehabilitated, psychological input and assessments continued. In conclusion, ECMO as a bridge to paediatric heart transplant has a low mortality. Morbidity is high and adequate resources need to be allocated for a multidisciplinary team to help these children return to a normal life. Patient details and duration of stay in each area in days Sex
Age
Weight in Kg
Diagnosis
Days ECMO
ITU Post op
HDU Post op
LDA Post op
F F M F F F M F
11 12 16 15 14 9 4 11
31.6 44.0 35.0 60.0 36.0 27.0 17.0 40.0
MV surgery MV surgery Cardiomyopathy Cardiomyopathy Cardiomyopathy Cardiomyopathy Cardiomyopathy Cardiomyopathy
7 DAYS 11 8 2 6 14 11 12
7 53 22 7 22 18 26 23
3 16 15 19 16 8 8 8
10 15 4 30 30 5 3 21
Age ⫽ years, LDA ⫽ low dependency area.
174 ASPECTS OF ADHERENCE TO THE TREATMENT REGIMEN FOLLOWING HEART OR HEART-LUNG TRANSPLANTATION IN YOUNG PEOPLE J.C. Wray,1 S. Waters,2 T. Sensky,2 R.C. Radley-Smith,1 1PSU, Harefield Hospital, Harefield, Middlesex, United Kingdom; 2Imperial College School of Medicine, London, United Kingdom
Non-adherence to medical treatment has emerged as a significant problem in transplantation (tx) and has particularly been associated with adolescence. There is little research on the risk factors for non-adherence in heart and heart-lung transplant patients but it has been suggested that up to a third of patients are non-adherent to some aspects of the treatment regimen. Fifty adolescents and young adults (24 males, 26 females; mean age: 17.9 years, range 12.3-24.9 years) who had undergone heart (n⫽42) or heart-lung (n⫽8) tx 1.4-14.9 years (mean 8.8 years) previously were asked to complete the Beliefs about Medication Questionnaire (BMQ), Perceived Illness Experience (PIE) scale and a demographics questionnaire. The notes of all patients were reviewed for information regarding previous psychiatric referral, rejection episodes and complications and noted concerns about adherence. Forty completed questionnaires were received and in 11 (28%) non-adherence to treatment was reported. It was also documented in the clinical notes of 9 (18%) of the patients. Non-adherence recorded in the notes was classified as intentional non-adherence and was correlated with lack of exercise (p⫽.032), psychiatric referral (p⫽.009) and lymphoma (p⫽.009). Non-adherence determined from the questionnaires was classified as unintentional and related to forgetting to take medication. Unintentional non-adherence was correlated with high scores on the preoccupation with illness (p⫽.041) and difficulties at school (p⫽.009) subscales of the PIE. In conclusion, more than a quarter of the sample demonstrated non-adherence to the treatment regimen. In contrast to previous research, we found that unintentional non-adherence is associated with different factors to intentional non-adherence. Future research is required to determine whether unintentional non-adherence results in significant medical complications in the longer term and how a reduction in the prevalence of non-adherence can be facilitated. 175 A COMMUNITY-BASED WEIGHT MANAGEMENT PROGRAM FOR CARDIAC TRANSPLANT RECIPIENTS: RESULTS OF A PILOT STUDY J.J. Salyer,1 M.P. Flattery,2 P.L. Joyner,3 R.K. Elswick,4 1Adult Health Nursing, Virginia Commonwealth University School of Nursing, Richmond, VA; 2Cardiothoracic Nursing, Medical College of Virginia Hospitals of Virginia Commonwealth University, Richmond, VA; 3 Nursing, McGuire Veterans Administration Medical Center, Richmond, VA; 4Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA Purpose: After cardiac transplant (tx), obesity, dyslipidemia, and hypertension are common and thought to be related to triple-drug immunosuppression and poor adherence to diet and exercise prescriptions. A lifestyle intervention that allows recipients to attend a community-based weight management program may improve health outcomes. The purpose of this study is to determine: (1) the effects of attending a community-based weight management program on weight loss, SBP, DBP, and lipid profile, and (2) the feasibility and acceptability of using a community-based program for weight management. Procedure: 21 patients (81% male; age⫽57; 99.7 mo. post-tx; 139% of IBW) participated in a randomized clinical trial and recieved either weight loss counselling from a registered dietician (usual care) or a 6-mo. Weight Watchers (WW) scholarship (treatment). Results: At baseline, there were no differences between groups in demographics. There were also no differences in outcome variables except weight (control ⫽ 102.1 Kg vs. treatment ⫽ 98.3 Kg; p⫽.047). Using a simple ANCOVA model with baseline values serving as covariates, group differences in outcomes were assessed and are
The Journal of Heart and Lung Transplantation Volume 22, Number 1S reported as adjusted means. After 6 months, significant changes were found in weight (control⫽100.5 Kg; treatment⫽95.6 Kg; p⫽.047) and HDL (control ⫽40.6mg/dl; treatment⫽49.1mg/dl; p⫽.044). A marginally significant difference was found in SBP (control⫽138mmHg; treatment⫽121mmHg; p⫽.07). A clinically significant decrease in DBP (6 mmHg) was noted which was attributed to treatment effect (p⫽.16). No differences were noted in cholesterol, triglycerides, or LDL. WW participants (n⫽10) attended an average of 24 of 26 meetings; 100% rated the program as acceptable. Meeting locations/times were rated as convenient. Group discussion was considered beneficial in managing weight loss. Conclusions: The WW Program appears to be an effective, feasible, & acceptable alternative to usual care.
176 LVAD DRIVELINE INFECTIONS IN THE MODERN ERA : INCIDENCE RISK FACTORS AND STRATEGIES FOR REDUCTION E.A. Stanford, L.J. Carozza, S. Winowich, J.S. Sapirstein, L.L. Shears, R.L. Kormos, Department of Surgery, University of Pittsburgh, Pittsburgh, PA Since 1998, 84 patients have received a ventricular assist device (VAD) as a bridge to cardiac transplantation (TRX) in a single center. Purpose: To examine factors predisposing to VAD driveline infection (DI) during two eras (1998-1999⫽I, 2000-2002⫽II) of implantation during which time driveline management protocols were altered in frequency and methodology. Methods: Patient data was collected prospectively into a database and analyzed for frequency and risk factors associated with DI. Data: There were 22 LVAD⬘s and 15 BiVAD⬘S in Era I and 20 LVAD⬘s and 27 BiVAD⬘s in Era II. There were no differences between patients in Era I vs. II based upon etiology or acuteness of onset of severe CHF, nor between gender, age, and size, pre-implant length of hospital stay or pre-implant hemodynamics or renal or hepatic function. Overall length of VAD support was longer in Era I vs II (168 vs 81days, p⬍0.01). Actuarial freedom from DI at 6 months in Era I patients was 24% compared to 70 % in Era II. DI⬘s were present in 59% of LVAD⬘s and 60% of BiVAD⬘s in Era I and in 10% of LVAD⬘s and 18% of BiVAD⬘s in Era II. Patients in Era I who developed DI⬘s had longer support times than those in Era II (235 vs. 68 days, p⬍0.01), and more frequent reoperations (43% vs. 78%, p⬍0.05). Patients in Era II who developed Di⬘s had a higher peak creatinine pre-implant than era II patients ( 4.2 vs. 2.2, p⬍ 0.01), and a lower pre-implant hemoglobin ( 9.6 vs. 11.2, p⬍0.02). In addition, there were more patient with post-implant renal failure in Era II patients with DI ( 60% vs. 12%, p⬍0.04). In addition, blood stream infection was seen in 16% of patients without DI vs. 55% of those with DI regardless of Era. Conclusion: Although DI⬘s have been significantly reduced in both LVAD⬘s and BiVAD⬘s due to changes in management strategies, patients with renal dysfunction are still at risk of DI which increases the risk of bacteremia.
177 ADHERENCE TO SELF-MONITORING PROTOCOLS AFTER LUNG TRANSPLANT J.B. Rea,1 C.M. Lawrence,1 J.W. Curl,1 K.G. Setliff,1 R.D. Davis,2 S.M. Palmer,3 1Advanced Practice Nursing, Duke University Health System, Durham, NC; 2Cardiothoracic Surgery, Duke University Health System, Durham, NC; 3Pulmonary and Critical Care Medicine, Duke University Health System, Durham, NC
Abstracts
S131
Purpose: Early detection of abnormalities in pulmonary function after lung transplant may lead to more effective therapeutic interventions. Patients at our institution are therefore instructed to monitor their FVC and FEV1 daily and report declines of 10% or more. Anecdotal experience indicates that many patients do not adhere to this recomendation despite repeated instruction. This single center, prospective, observational study was designed to describe patient adherence to self-monitoring protocols after lung transplant. Procedures: Patients were given a Likert scale questionnaire addressing self-monitoring frequency of spirometry, blood pressure, temperature, weight, and blood work. Questionnaires were handed to 119 randomly selected adult lung transplant recipients who had at least one year of post-transplant follow-up during clinic appointments, 54 questionnaires were returned. Summary: Of the respondents, 23 (44%) monitored spirometry daily, 22 (42%) monitored blood pressure daily, 19 (37%) monitored temperature daily, 28 (54%) monitored weight daily, and 23 (44%) monitored monthly blood work. Only 9 (17%) reported following all recommended frequencies of self-monitoring. No significant differences were found between those adherent and non-adherent to daily spirometry self-monitoring with respect to age, sex, race, or preoperative diagnosis. Patients who received bilateral lung transplants reported superior adherence to self-monitoring (p⫽0.04). Additionally, there was a trend toward decreasing adherence with increasing time elapsed since transplant (p⫽0.10). Conclusion: Despite instruction about the importance of self-monitoring for early detection and intervention, most patients do not adhere to self-monitoring protocols. Patients become more complacent about self-monitoring over time. The differences observed between single and bilateral lung transplant recipients warrant further study. Additional interventions to improve adherence to self-monitoring should be devised, tested, and implemented. 178 WHAT CONTRIBUTES TO EMOTIONAL DISTRESS IN FEMALE HEART TRANSPLANT RECIPIENTS? I. Gerard,1 L.V. Doering,1 L. Evangelista,1 K. Dracup,2 J. Kobashigawa,3 1School of Nursing, University of California Los Angeles, Los Angeles, CA; 2School of Nursing, University of California San Francisco, San Francisco, CA; 3School of Medicine, University of California Los Angeles, Los Angeles, CA Emotional distress after heart transplant (HT) is associated with higher incidence of rejection and increased morbidity. Although depression and anxiety are more prevalent in women with other cardiac conditions, their level of emotional distress following HT is unknown. This study’s purpose was to describe the prevalence of dysphoria in female HT recipients and explore associated variables. Methods: Fifty female HT recipients (age 54.7⫾13.0 years, time from transplant 5.1⫾4.4 years, 69% Caucasian, 64% ischemic heart failure (HF) etiology, 92% receiving triple immunosuppressive regimen (ISR) were enrolled during a routine clinic visit and completed the Multiple Affect Adjective Checklist. Demographic and clinical variables were identified by chart abstract. Rejection rate was defined as the proportion of endomyocardial biopsies graded 1 - 3 (any rejection). Data were analyzed using univariate correlations and multiple linear regression. Results: Eighty percent reported symptoms above normative values for at least 1 of 3 dysphoric states (depression, anxiety, or hostility). Seventy-two percent reported ⱖ2 dysphoric states. Symptoms were not correlated with age, marital status, time since transplant, LVEF, or comorbidities. HF etiology, ISR, and rejection history accounted for 30.0% (p⫽.001), 29.4% (p⬍.000), and 26.7% (p⬍.004) of the variance