Psychological and Cognitive Factors Associated With Nonadherence to Post-Cardiac Transplant Treatment

Abstract

Study aims

To examine the association of psychological and cognitive indicators with treatment nonadherence following heart transplantation.

Methods

A cross-sectional exploratory study was conducted in a single heart transplant center. The study included 74 heart transplant patients (42 men, 56.8%), with a mean age of 54.1 (SD±12.7), assessed at least 6 months after transplantation. The instruments used were GAD-7 (anxiety symptoms), PHQ-9 (depression symptoms), MoCA-B (cognitive screening), the Inventory of perceived barriers related to self-care after heart transplantation, and BAASIS (adherence to the immunosuppressant meds).

Results

Based on the past 4 weeks' recall, nonadherence behavior was observed in 59.5% (n=44) of the participants. Difficulties of adherence to immunosuppressant therapy occurred during the adherence process in the initiation phase (8.1%, n = 6), implementation phase (52.7%, n = 39), and persistence phase (2.7%, n = 2) of the BAASIS model. Nineteen patients (25.7%) missed doses of immunosuppressant medication, and 44.6% (33 patients) altered their medication schedule in the past month. Anxiety symptoms (GAD-7) and patient-level perceived barriers were associated with nonadherence (BAASIS). Mild cognitive impairment was found in 10.8% (n = 8) but did not associate with nonadherence. Among participants, 64.9% (n=48) experienced complications after their transplant.

Conclusion

Anxiety, perceived barriers to treatment and self-care, may all contribute to nonadherence. These findings underscore the importance of screening for psychological and cognitive indicators in the post-cardiac transplant period. Healthcare professionals must proactively evaluate and support the psychological concerns of patients after heart transplantation, as they play a potential role in nonadherence behavior.