Adherence to the therapeutic regimen in heart, lung, and heart-lung transplant recipients.
Optimal outcome after heart, lung, and heart-lung transplantation can only be obtained if patients are supported in adhering to a lifelong therapeutic regimen. The transplant patient's therapeutic regimen consists of a lifelong medication regimen, including immunosuppressive drugs; monitoring for signs and symptoms related to complications; avoidance of risk factors for cardiovascular disease and cancer (ie, diet and exercise prescriptions, nonsmoking); avoidance of abuse/dependence of alcohol or illegal drugs, as well as attending regular clinical checkups. Nonadherence to all aspects of this regimen is substantial. Nonadherence has been related to negative clinical outcome in view of acute rejections, graft vasculopathy, higher costs, and mortality. This review focuses on the prevalence, correlates, and consequences of nonadherence to the therapeutic regimen in heart, lung, and heart-lung transplantation. The current state of the-art on adherence-enhancing interventions is reported. Priorities for future research are outlined.
De Geest
Sabina
S
Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland. Sabina.DeGeest@unibas.ch
Dobbels
Fabienne
F
Fluri
Christa
C
Paris
Wayne
W
Troosters
Thierry
T
D000359:Aftercare; D001071:Appointments and Schedules; D016903:Drug Monitoring; D015444:Exercise; D006293:Health Promotion; D006301:Health Services Needs and Demand; D016027:Heart Transplantation / Q000009:adverse effects / Q000523:psychology*; D016041:Heart-Lung Transplantation / Q000009:adverse effects / Q000523:psychology*; D006699:Home Care Services; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008019:Life Style; D008134:Long-Term Care; D016040:Lung Transplantation / Q000009:adverse effects / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care / Q000523:psychology; D000074606:Smoking Prevention; D012944:Social Support; D012959:Socioeconomic Factors; D013147:Spirometry; D019966:Substance-Related Disorders / Q000517:prevention & control