Depressive Symptoms, Physical Activity, and Post-Transplant Outcomes: The ADAPT Prospective Study

Abstracts want to connect with their donor families. The purpose of this study was to ask heart donor families what they thought about current practices around anonymity. Methods: This was a phenomenologically informed audiovisual qualitative study. Inclusion criteria: ability to provide informed consent, having consented to heart donation, between 1 and 10 years after consent to donation, ability to communicate their experiences with clarity. Semi-structured open ended interviews were conducted in their homes, by an experienced qualitative interviewer. Interviews were audio/ video-taped to capture voice and body language and were transcribed verbatim. Data collected also included personal artifacts (e.g. photos, letters) and field notes. Analysis involved coding language, bodily gestures, volume and tone in keeping with our phenomenologically informed visual method. Results: Mean time since donation was 61.7 months (§ 31.01; range 15115 months). 22 donor families (40 participants) were interviewed from across Canada (27% Alberta, 32% Ontario & 41% B.C). Mean interview duration was 72 minutes (range 19-149). Four key themes emerged relating to anonymity: 21/22 families wanted to know the recipient(s), 19/22 wanted to meet the recipient(s). 17 had received letters from the recipient (s) and 12 had sent letters. Those who didn’t write a letter frequently cited concerns around 3rd party vetting and redaction as a barrier. 21 of 22 donor families wanted to meet their recipients, and wanted to see policy change to enable this. Conclusion: Donor families want to know and meet the recipients. This is in keeping with the views of heart transplant recipients who wish to know their donor families. We believe it is time to re-assess current policies on anonymity in transplantation. Donor families raised many possible solutions to how this may be accomplished. 205 Universal Depression Screen of Ambulatory Cardiac Transplant Recipients is Feasible and Identifies a Subset of Patients That May Benefit from Mental Health Intervention L. Peters, L. Rosenthal, H. Monroe, M. Dierks, A. Ambardekar and C. McIlvennan. University of Colorado, Aurora, CO. Purpose: Patients with a heart transplant who have depression have higher rates of graft failure and noncompliance; however, patients identified and treated early have outcomes similar to those without depression. The aim of this quality improvement project was to assess feasibility of implementing a universal depression screen—via the Patient Health Questionnaire (PHQ)-in a busy ambulatory heart transplant clinic. Methods: Heart transplant team members were educated via an online module about depression screening. The PHQ was embedded in the electronic health record. Depression screening (PHQ2) was performed by an RN during the check-in process. For those patients who screened positive for depression (PHQ2 ≥3), the PHQ9 was administered. Patients who scored positive for moderate or severe depression (PHQ9 ≥10) received a follow-up phone call and referral to mental health services. Primary outcomes were the percentage of patients who underwent successful depression screening and received follow-up. Secondary outcomes included average time for completion of depression screening and level of burden for team members (5-point Likert scale, 5=significant burden, 1=no burden at all). Results: From July-September 2018, there were 388 clinic visits; PHQ2 screens were completed during 363 (94%) of those visits. There were 223 unique patients seen during this time, of which 214 underwent a depression screening assessment. Initial PHQ2 identified 21 patients (6%) who screened positive for depression, of which all 21 had PHQ9 assessment. The PHQ9 identified 17 patients (4%) as having moderate or severe depression. All 17 patients were provided with mental health resources and received follow-up phone calls. Median time to administer PHQ2 was 2 minutes (range 1-2). Median time to administer PHQ9 was 5 minutes (range 5-15). Mean transplant provider burden score for depression screening was 1.6 (range 1-2).

S93 Conclusion: Implementation of routine universal depression screening in an outpatient heart transplant clinic is feasible, identifies patients with depression, and does not result in clinical burden. Further investigation is needed to determine whether this universal depression screening and resultant early referral to mental health services positively effects long-term graft and patient survival. 206 Depressive Symptoms, Physical Activity, and Post-Transplant Outcomes: The ADAPT Prospective Study P.J. Smith, C. Frankel, D. Bacon, E. Bush and L. Snyder. Duke University Medical Center, Durham, NC. Purpose: Increasing evidence suggests that greater depressive symptoms and reduced functional exercise capacity are associated with worse clinical outcomes following lung or heart transplantation. No studies, however, have prospectively assessed the associations between post-transplant depressive symptoms, actigraphy-assessed PA levels, and subsequent clinical outcomes in ambulatory transplant recipients. Methods: The ADAPT prospective study (Assessing Depression And Physical activity following Transplant) assessed depressive symptoms and PA among lung or heart transplant recipients, enrolled between July, 2016 and May, 2017 and followed for up to two years. Participants were assessed for depression and PA levels approximately six months following transplantation during routine clinic visits using the Centers for Epidemiologic Studies of Depression scale (CESD) and continuous actigraphy (Actigraph GT3X) over a one-week period. Participants were then followed until at least the end of the first posttransplant year for clinical events (unplanned transplant-related hospitalizations during first year or death), which were examined using clustered, time-to-event Cox proportional hazards models through the Wei-Lin-Weissfeld methodology, controlling for transplant hospitalization length of stay. Results: Sixty-six transplant recipients were enrolled, including 42 lung and 24 heart recipients. Participants exhibited subclinical depressive symptoms (mean CESD = 9.4 [SD = 8]), with only a subset (22%) demonstrating levels suggestive of clinical depression. Participants tended to be sedentary, with the majority of daily activity (61%) spent within the ‘sedentary’ level and an average daily step count of 7188 (SD = 2595). During followup, 19 participants (29%) experienced at least one hospitalization and two participants died. Greater levels of depression (HR = 2.11 [1.58, 2.82], P <.001) and lower intensity PA (HR = 0.45 [0.24, 0.84], P = .012) were both independently predictive of worse clinical outcomes after accounting for transplant LOS. Conclusion: Greater depressive symptoms and lower PA are both independently predictive of worse clinical outcomes following lung or heart transplantation, suggesting these are two highly important therapeutic areas to evaluate and target for treatment post-transplant. 207 PTSD in Tx ICU Nurses M. Sanchez,1 A. Simon,2 and D. Ford.1 1Psychological Medicine, Royal Brompton & Harefield NHS Foundation Trust, Harefield, Middlesex, United Kingdom; and the 2MCS and Cardiothoracic Transplantation, Royal Brompton & Harefield NHS Foundation Trust, Harefield, Middlesex, United Kingdom. Purpose: Developments in surgical technique has led to increasing complexity in clinical caseload in transplant intensive care units (ICU) in the UK. The ICU nurse plays a pivotal role in the safe and effective delivery of this complex care. Studies suggested that that ICU nurses experience a greater prevalence of post traumatic stress disorder (PTSD) in comparison with general nurses. There is evidence to suggest that symptoms of PTSD correlate with greater staff burnout and absence rates, which in turn have a financial implication for healthcare providers. This study examined PTSD