title: Determinants of quality of life changes among long-term cardiac transplant survivors: results from longitudinal data.
abstract: BACKGROUND
  Cross-sectional analyses have identified significant associations between quality of life (QOL), and comorbidities and adverse effects in cardiac transplant recipients. However, little is known about factors that influence changes in QOL over time. This study examines both cross-sectional and longitudinal data from long-term survivors to identify factors that affect differences in QOL among recipients and individual changes in QOL during a 1-year period.
  
  
  METHODS
  Self-selected enrollees completed questionnaires, including QOL scales, at 3-month intervals. Repeated measures multiple regression analysis was used to examine the association between the QOL scales and comorbidities, adverse effects, and compliance measures, controlling for other factors.
  
  
  RESULTS
  We included 569 participants in the analysis, with a mean time since transplantation of 8.6 years. Cross-sectional results showed that the number of comorbidities, treatment non-compliance, and several adverse effects were associated with low QOL. In longitudinal results, waiting to take medications and taking less medication because of lifestyle restrictions were associated with decreases in QOL over time. Hair loss, changes in face shape, and decreased sexual interest or ability also had the largest adverse effects on changes in QOL.
  
  
  CONCLUSIONS
  These findings provide new opportunities for interventions to address factors related to decreases in QOL. Clinicians should actively solicit information about compliance with medication regimens. In addition, information about the adverse effects of medications should be considered when making therapeutic decisions.
authors.affiliation: Department of Cardiothoracic Surgery, University of Southern California, Keck School of Medicine, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033-4612, USA. mbarr@surgery.usc.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Barr
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Schenkel
authors.forename: Annalisa
authors.initials: A
authors.lastname: Van Kirk
authors.forename: R J
authors.initials: RJ
authors.lastname: Halbert
authors.forename: J Harold
authors.initials: JH
authors.lastname: Helderman
authors.forename: Donald E
authors.initials: DE
authors.lastname: Hricik
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Matas
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: Bonita R
authors.initials: BR
authors.lastname: Siegal
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Ferguson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Nordyke
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality / Q000523:psychology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents