Psychological predictors of mortality in heart transplanted patients: a prospective, 6-year follow-up study.
BACKGROUND
Some reports suggest a link between poor psychological adjustment to heart transplantation and an increased risk of subsequent adverse clinical outcome. Despite its prognostic and therapeutic implications, this issue is still lacking adequate empirical studies. We prospectively tested the predictive value of a complete set of psychiatric and psychological variables, collected with both self-rating and observer-based instruments at midterm after heart transplantation, on the subsequent 6-year survival status.


METHODS
Ninety-five heart transplanted patients underwent the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-4th Edition and the structured interview for Diagnostic Criteria for Psychosomatic Research and filled three questionnaires assessing the dimensions of psychological distress, quality of life, and psychological well-being. Demographic characteristics and several clinical parameters were also collected. A 6-year follow-up survival was performed.


RESULTS
Analyses of survival showed that hostility, depression, purpose in life, the occurrence of at least one cardiac event, chronic renal insufficiency, diabetes, number of drug prescriptions, a New York Heart Association (NYHA) class more than or equal to II, and ischemic origin of the cardiopathy significantly predicted subsequent survival duration. When multivariate analyses were performed, high levels of hostility and the presence of diabetes resulted the independent predictors of survival status.


CONCLUSIONS
These findings point out the predictive role of specific components of psychological adjustment to heart transplantation and pose the basis for the evaluation of whether the provision of pharmacologic and psychotherapeutic interventions, aimed at reducing the empirically identified psychological risk factors, may result in a better long-term outcome.
Sirri
Laura
L
Department of Psychology, University of Bologna, Bologna, Italy. laurasirri@libero.it
Potena
Luciano
L
Masetti
Marco
M
Tossani
Eliana
E
Magelli
Carlo
C
Grandi
Silvana
S
D000368:Aged; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality* / Q000523:psychology*; D006791:Hostility; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000401:mortality; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents