Objective: to assess the dynamics of quality of life (QoL) in patients after heart transplantation (HTx) and to identify factors associated with its changes.
Materials and methods: We retrospectively analyzed our registered original database “Psychological status of patients after heart transplantation” (No. 2023622138). From January 2010 to February 2024 HTx was performed in 244 patients. The inclusion criteria for this study were: recipients over 18-year-old with preserved heart transplant function (LVEF Simpson more than 55%), whose follow-up after HTx was more than 3 years. After inclusion in the HTx waiting list (HTx WL), patients completed the SF-36 questionnaires and a coping test, then in 3-6 months, 1 and 3 years after HTx - SF-36, a coping test and the International physical activity questionnaire (IPAQ).
Results: The mean age of patients enrolled in the study (n=112; 84 men) was 48±11-year-old. According to the results of SF-36 heart recipients improved most of the indicators of physical QoL, except for Bodily Pain (BP), while the level of mental QoL increased by 3-6 months and did not undergo significant changes thereafter. According to the results of the Lazarus coping test, during the 1st year the level of coping mechanisms did not change, but by 3 years after HTx there was a positive dynamic in the form of a gradual decrease. In the first 3-6 months one third of the patients were physically active (PA), the rest continued their sedentary lifestyle. After HTx, the number of PA recipients increased, and after 3 years they accounted for only half of the observed patients. According to the results of the SF-36 and the coping test, the following components of QoL (Role-Physical Functioning, Role-Emotional, BP, Vitality) and self-control coping strategy were higher in PA recipients while the coping mechanism of escape-avoidance was lower; other indicators did not change depending on physical activity (p>0.05). Going back to work did not affect scores of analyzed questionnaires. During 1st year there were no significant correlations between QoL indicators and recipients’ sex, duration of stay in the HTx WL and in the ICU after HTx, or the use of mechanical circulatory support prior to HTx (p>0.05). At the 3-year point after HTx, mental health of QoL (R = 0.79; p=0.0005) was associated with the recipient’s male sex (0.54), haemoglobin level (0.53) and coping strategies of escape-avoidance (-0 .73) and confrontation (0.54).
Conclusions: After HTx physical QoL improved, remaining at a stable level during 3 years follow-up, and its positive dynamics were directly related to being PA. In 3 years only half of the heart recipients were PA. Older age and lack of physical activity were factors that negatively affected the dynamics of QoL after HTx. The main factors that improved mental health in long-term follow-up were male sex, haemoglobin level, a lower level of the coping mechanism of escape-avoidance and a higher level of confrontation.