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Differential vulnerability to psychiatric distress after lung vs. heart transplantation
S128
Abstracts
Results: We found that elderly patients were more compliant with diet (77% vs. 65%, p⫽.001) and exercise (67% vs. 55%, p⫽.021) than younger patients. There was no difference in other compliance behaviors (keeping appointments, medication, smoking/alcohol use). Of the 70 elderly patients, 51% reported difficulty complying with exercise while 37%, 24%, and 23% had difficulty with diet, keeping appointments, and medication use, respectively. Nine percent and 18% continued to smoke and drink. Common barriers that led to noncompliance with keeping appointments and taking medications were lack of transportation, time and money. Lack of motivation, self-control, and support led to poor compliance with diet and smoking/alcohol use, while physical symptoms and lack of energy accounted for poor exercise compliance. We found a strong association (p⬍.01) between degree of difficulty and actual compliance with each of the medical regimens in elderly HF patients. Conclusion: Elderly HF patients report low compliance behaviors that are associated with degree of difficulty following prescribed regimens. Interventions that target the common barriers cited by elderly patients may be key to improved compliance behaviors in this vulnerable population.
167 HEALTH RELATED QUALITY OF LIFE OF ELDERLY PATIENTS WITH END-STAGE HEART FAILURE L.V. Doering,1 L.S. Evangelista,1 K. Dracup,2 M.A. Hamilton,3 G.C. Fonarow,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 Recent findings that elderly heart transplant recipients fare as well as younger ones raises the intriguing possibility that health-related quality of life (HRQOL) in end-stage HF may not be an age-dependent phenomenon, as previously assumed. Purpose: We conducted a crosssectional survey to 1)compare overall HRQOL, emotional and physical domains of HRQOL, and functional ability in elderly ( ⱖ 65 years) and younger ( ⬍ 65 years) HF patients, and 2) identify factors that predict HRQOL in elderly patients with end-stage HF. Methods: During a visit to a HF clinic, 87 elderly patients (age 69.8 ⫾ 5.1 years, New York Heart Association (NYHA) class III-IV 44%, ischemic etiology 61%) and 154 younger patients (age 50.6 ⫾ 9.8 years, NYHA class III-IV 35%, ischemic etiology 30%) completed the Minnesota Living with Heart Failure Questionnaire (LHFQ) , the SF-12, the Beck Depression Inventory, the MOS Social Support Scale and a 6-minute walk test (6MWT). Data were analyzed using analysis of variance, with Bonferoni correction for multiple comparisons, and multiple regression. Results: When NYHA class was controlled, there was an age effect for physical domains of HRQOL (SF-12 PCS: F ⫽ 13.6,p ⬍ .001; LHFQphysical: F ⫽ 10.2, p ⫽ .002) only. There were no age, gender or age by - gender interactive effects on overall HRQOL or on emotional domains of HRQOL. For elderly HF patients, a model including NYHA class, gender, 6MWT distance, depressive symptoms, and social support explained 45.3% of the variance in overall HRQOL (p ⫽ .000). Only NYHA ( ⫽ .24, p ⫽ .005) and depressive symptoms ( ⫽ .56, p ⫽ .000) were independently associated with overall HRQOL. Conclusions: Elderly HF patients fare as well emotionally and in terms of overall HRQOL as younger patients, but have poorer HRQOL in physical domains. Greater severity in symptoms of dyspnea, fatigue, and depression are associated with poorer HRQOL in elderly HF patients.
The Journal of Heart and Lung Transplantation January 2003 168 DIFFERENTIAL VULNERABILITY TO PSYCHIATRIC DISTRESS AFTER LUNG VS. HEART TRANSPLANTATION M.A. Dew,1 R.L. Kormos,2 A.F. DiMartini,1 J.M. Goycoolea,1 J.D. Manzetti,2 K.R. McCurry,2 1Psychiatry, Univ. of Pittsburgh; 2 Surgery, Univ. of Pittsburgh, School of Medicine & Medical Center, Pittsburgh Objective: In contrast to an extensive literature on psychiatric outcomes after heart transplantation (tx), little is known about rates, course, or predictors of psychiatric distress in lung recipients. Whether psychosocial factors that increase vulnerability for distress in heart patients would similarly affect lung patients is unknown. We compared the prevalence and risk factors for depressive and anxiety-related symptoms in lung vs. heart recipients. Procedures: 88 patients (41 heart, 47 lung recipients; 92% of the eligible population transplanted between 11/999/01) were enrolled in a 12-mo. prospective study, with structured psychiatric and psychosocial evaluations at 2-, 7-, and 12-mos. post-tx. Results: Rates of clinically significant distress were elevated over normative rates, especially in the early months post-tx in which 58% of the sample showed elevated depression and/or anxiety levels. While both lung recipients⬘ and heart recipients⬘ symptom levels significantly improved with time, the improvement was greater for lung recipients. Psychosocial variables reflecting mental health history and social supports had similar effects in both groups: patients with histories of personality pathology, poorer family and friend supports, and weaker religious faith showed significantly higher distress at all timepoints. In contrast, differential effects were observed in lung vs. heart recipients for psychosocial variables reflecting coping strategies, self-esteem, and employment status. High use of avoidance strategies to manage health problems, and failure to use active behavioral strategies, exacerbated depressive symptom levels only in lung recipients. Low self-esteem and re-employment early post-tx led to prolonged depression and anxiety symptoms in heart but not lung recipients. Conclusions: Distinct patterns of mental health adjustment, plus evidence that psychosocial factors related to coping, self-esteem, and employment may have different effects in lung vs. heart recipients, indicate the need to tailor psychosocial interventions to each patient group. 169 RISK/BENEFIT-BASED LUNG ALLOCATION ALGORITHMS S. Murray,1,2 J. Yu,2 R.A. Wolfe,1,2 R. Merion,1,2 K. McCullough,2 R. Bustami,2 T. Egan,3 F. Grover,4 1SRTR, URREA, Ann Arbor, MI; 2 U Michigan, Ann Arbor, MI; 3U North Carolina, Chapel Hill, NC; 4U Colorado, Denver, NO Patients (pts) awaiting lung transplantation (LTX) are prioritized largely by waitlist (WL) time. The current donor shortage suggests maximizing the benefit of LTX among WL pts. A practical allocation system would give priority to patients at high risk of death while on the WL while avoiding futile transplants for candidates whose prognosis is poor with a transplant. We propose candidate measures of potential LTX benefit for ranking WL pts based on models for WL and post-LTX survival in 4 diagnosis (Dx) groups. For each Dx group, let x1,. . .,xp and HR1,. . .,HRp be the values of Dx-specific pt WL factors and their associated Cox model hazard ratio estimates (HRs). At listing with factors x1,. . .,xp, the estimated chance of surviving on the WL a years (yrs) is S(a兩x) ⴝ [So(a)]ˆ[HR1x1. . .HRpxp], where So(a) is the estimated baseline WL survival function. After surviving t yrs on the WL, the chance of survival on the WL a more yrs is S(t⫹a兩x)/S(t兩x). Similarly define y1,. . .,yq and HR 1,. . .,HR q as potentially different post-LTX pt
Abstracts
Results: We found that elderly patients were more compliant with diet (77% vs. 65%, p⫽.001) and exercise (67% vs. 55%, p⫽.021) than younger patients. There was no difference in other compliance behaviors (keeping appointments, medication, smoking/alcohol use). Of the 70 elderly patients, 51% reported difficulty complying with exercise while 37%, 24%, and 23% had difficulty with diet, keeping appointments, and medication use, respectively. Nine percent and 18% continued to smoke and drink. Common barriers that led to noncompliance with keeping appointments and taking medications were lack of transportation, time and money. Lack of motivation, self-control, and support led to poor compliance with diet and smoking/alcohol use, while physical symptoms and lack of energy accounted for poor exercise compliance. We found a strong association (p⬍.01) between degree of difficulty and actual compliance with each of the medical regimens in elderly HF patients. Conclusion: Elderly HF patients report low compliance behaviors that are associated with degree of difficulty following prescribed regimens. Interventions that target the common barriers cited by elderly patients may be key to improved compliance behaviors in this vulnerable population.
167 HEALTH RELATED QUALITY OF LIFE OF ELDERLY PATIENTS WITH END-STAGE HEART FAILURE L.V. Doering,1 L.S. Evangelista,1 K. Dracup,2 M.A. Hamilton,3 G.C. Fonarow,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 Recent findings that elderly heart transplant recipients fare as well as younger ones raises the intriguing possibility that health-related quality of life (HRQOL) in end-stage HF may not be an age-dependent phenomenon, as previously assumed. Purpose: We conducted a crosssectional survey to 1)compare overall HRQOL, emotional and physical domains of HRQOL, and functional ability in elderly ( ⱖ 65 years) and younger ( ⬍ 65 years) HF patients, and 2) identify factors that predict HRQOL in elderly patients with end-stage HF. Methods: During a visit to a HF clinic, 87 elderly patients (age 69.8 ⫾ 5.1 years, New York Heart Association (NYHA) class III-IV 44%, ischemic etiology 61%) and 154 younger patients (age 50.6 ⫾ 9.8 years, NYHA class III-IV 35%, ischemic etiology 30%) completed the Minnesota Living with Heart Failure Questionnaire (LHFQ) , the SF-12, the Beck Depression Inventory, the MOS Social Support Scale and a 6-minute walk test (6MWT). Data were analyzed using analysis of variance, with Bonferoni correction for multiple comparisons, and multiple regression. Results: When NYHA class was controlled, there was an age effect for physical domains of HRQOL (SF-12 PCS: F ⫽ 13.6,p ⬍ .001; LHFQphysical: F ⫽ 10.2, p ⫽ .002) only. There were no age, gender or age by - gender interactive effects on overall HRQOL or on emotional domains of HRQOL. For elderly HF patients, a model including NYHA class, gender, 6MWT distance, depressive symptoms, and social support explained 45.3% of the variance in overall HRQOL (p ⫽ .000). Only NYHA ( ⫽ .24, p ⫽ .005) and depressive symptoms ( ⫽ .56, p ⫽ .000) were independently associated with overall HRQOL. Conclusions: Elderly HF patients fare as well emotionally and in terms of overall HRQOL as younger patients, but have poorer HRQOL in physical domains. Greater severity in symptoms of dyspnea, fatigue, and depression are associated with poorer HRQOL in elderly HF patients.
The Journal of Heart and Lung Transplantation January 2003 168 DIFFERENTIAL VULNERABILITY TO PSYCHIATRIC DISTRESS AFTER LUNG VS. HEART TRANSPLANTATION M.A. Dew,1 R.L. Kormos,2 A.F. DiMartini,1 J.M. Goycoolea,1 J.D. Manzetti,2 K.R. McCurry,2 1Psychiatry, Univ. of Pittsburgh; 2 Surgery, Univ. of Pittsburgh, School of Medicine & Medical Center, Pittsburgh Objective: In contrast to an extensive literature on psychiatric outcomes after heart transplantation (tx), little is known about rates, course, or predictors of psychiatric distress in lung recipients. Whether psychosocial factors that increase vulnerability for distress in heart patients would similarly affect lung patients is unknown. We compared the prevalence and risk factors for depressive and anxiety-related symptoms in lung vs. heart recipients. Procedures: 88 patients (41 heart, 47 lung recipients; 92% of the eligible population transplanted between 11/999/01) were enrolled in a 12-mo. prospective study, with structured psychiatric and psychosocial evaluations at 2-, 7-, and 12-mos. post-tx. Results: Rates of clinically significant distress were elevated over normative rates, especially in the early months post-tx in which 58% of the sample showed elevated depression and/or anxiety levels. While both lung recipients⬘ and heart recipients⬘ symptom levels significantly improved with time, the improvement was greater for lung recipients. Psychosocial variables reflecting mental health history and social supports had similar effects in both groups: patients with histories of personality pathology, poorer family and friend supports, and weaker religious faith showed significantly higher distress at all timepoints. In contrast, differential effects were observed in lung vs. heart recipients for psychosocial variables reflecting coping strategies, self-esteem, and employment status. High use of avoidance strategies to manage health problems, and failure to use active behavioral strategies, exacerbated depressive symptom levels only in lung recipients. Low self-esteem and re-employment early post-tx led to prolonged depression and anxiety symptoms in heart but not lung recipients. Conclusions: Distinct patterns of mental health adjustment, plus evidence that psychosocial factors related to coping, self-esteem, and employment may have different effects in lung vs. heart recipients, indicate the need to tailor psychosocial interventions to each patient group. 169 RISK/BENEFIT-BASED LUNG ALLOCATION ALGORITHMS S. Murray,1,2 J. Yu,2 R.A. Wolfe,1,2 R. Merion,1,2 K. McCullough,2 R. Bustami,2 T. Egan,3 F. Grover,4 1SRTR, URREA, Ann Arbor, MI; 2 U Michigan, Ann Arbor, MI; 3U North Carolina, Chapel Hill, NC; 4U Colorado, Denver, NO Patients (pts) awaiting lung transplantation (LTX) are prioritized largely by waitlist (WL) time. The current donor shortage suggests maximizing the benefit of LTX among WL pts. A practical allocation system would give priority to patients at high risk of death while on the WL while avoiding futile transplants for candidates whose prognosis is poor with a transplant. We propose candidate measures of potential LTX benefit for ranking WL pts based on models for WL and post-LTX survival in 4 diagnosis (Dx) groups. For each Dx group, let x1,. . .,xp and HR1,. . .,HRp be the values of Dx-specific pt WL factors and their associated Cox model hazard ratio estimates (HRs). At listing with factors x1,. . .,xp, the estimated chance of surviving on the WL a years (yrs) is S(a兩x) ⴝ [So(a)]ˆ[HR1x1. . .HRpxp], where So(a) is the estimated baseline WL survival function. After surviving t yrs on the WL, the chance of survival on the WL a more yrs is S(t⫹a兩x)/S(t兩x). Similarly define y1,. . .,yq and HR 1,. . .,HR q as potentially different post-LTX pt