Long term outcome of heart failure patients disqualified from heart transplantation.

BACKGROUND: The prognosis of patients with advanced heart failure is unfavourable. However, little is known about the survival of patients referred for heart transplantation but finally disqualified from transplantation due to contraindications. This study aimed to evaluate the prognosis of patients' disqualified from heart transplantation. METHODS: It was a retrospective study based on medical records of patients disqualified from heart transplantation. RESULTS: One hundred and fifty-one patients were included and 94 deaths were recorded during long-term follow-up (range 0.02-10.1 years). The survival rate at 5 years was 25%. The mean age of the studied population was 57.7 years and the majority of patients were males, 87.4%. The ischaemic aetiology (66.2%) was the most dominant aetiology of heart failure. In the Cox regression model, supervision by the specialist cardiology centre (HR 0.61;p = 0.04) and pharmacotherapy with beta-blockers (HR = 0.47;p = 0.02) positively influenced the prognosis. On the contrary, well-known heart failure risk factors like a renal failure (HR 1.59;p = 0.049), pulmonary hypertension (HR 1.55;p = 0.046), liver failure (HR 2.65;p = 0.02) were negative predictors of outcome. By Kaplan-Meier analysis, patients with other than pulmonary hypertension causes of disqualification from heart transplantation had a better survival rate, p = 0.047. CONCLUSIONS: The prognosis of patients disqualified from heart transplantation is unfavourable. However, some of the patients experience relatively long survival. Therefore, careful clinical assessment and identification of factors influencing prognosis may improve adequate patients' qualifications for heart transplantation.

Involvement in Health Behavior After Heart Transplantation: The Role of Personal Resources and Health Status. Single-Center Observational Study.

Introduction: Heart transplantation affects all spheres of the patients' functioning - their physical well-being and coping with everyday situations, as well as their identity and social functioning. Its long-term effects depend on the effective cooperation with the transplant team. Post-transplant patients are expected to be committed to adherence to recommendations. Patients' subjective characteristics could increase the risk of difficulties during treatment or might have a protective effect. The major aim of the study was to evaluate the level of engagement in health behavior in heart transplant recipients in relation to their personal resources, such as personality traits, and their health status. Material and Method: The observational ex post facto model was proposed. Participants completed a set of psychological questionnaires. In the study, there were used questionnaires regarding health behavior (HBI), personality traits (NEO-FFI), health locus of control (MHLC), self-efficacy (GSES) and health status (GHQ-28). The group included in the analyses consisted of 107 heart transplant patients. They ranged in age from 19 to 75 years; 10.3% of them were women. Results: According to norms, 71% patients reported high level of engagement in health behavior. There were significant differences in the level of dietary habits and other types of health behaviors. The best predictors of overall health behavior were conscientiousness (ß = 0.20, p < 0.05) and health locus of control (Powerful Others) (ß = 0.25, p < 0.05). The prophylaxis behavior was related significantly to the level of conscientiousness (p < 0.05) and health locus of control (Internal and Powerful Others) (p < 0.05; p < 0.01). The level of positive mental attitude was related significantly to agreeableness (p < 0.05), health locus of control (Powerful Others) (p < 0.01), and self-efficacy (p < 0.01). Everyday healthy practices were related significantly to openness to experience (p < 0.01) and health locus of control (all categories: Internal, Powerful Others and Chance) (p < 0.05; p < 0.01; p < 0.05, respectively). Conclusion: Majority of heart transplant patients is engaged in high level of health behavior. Among the various forms of health-relevant habits, heart transplant patients adhere significantly less frequently to a healthy diet. Among examined resources, the best predictors of caring about health are generalized self-efficacy and age at the time of HTx.

Prognostic value of novel biomarkers compared with detailed biochemical evaluation in patients with heart failure.

INTRODUCTION: The assessment of prognosis is crucial for the clinical management of patients with heart failure (HF). OBJECTIVES: The aim of the study was to evaluate the usefulness of novel biomarkers for the assessment of prognosis in patients with HF, compared with a detailed assessment based on routine laboratory tests. PATIENTS AND METHODS: The study included 179 patients with HF. In all patients, routine laboratory tests were performed and selected biomarkers were measured (N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, growth hormone, myeloperoxidase, metaloproteinase 9, procollagen type III, soluble toll like receptor 2, insulin growth factor, and neutrophil gelatinase-associated lipocain). The primary endpoint was death or urgent heart transplantation, while the secondary endpoints encompassed primary endpoints plus cardioverter intervention or hospitalization for HF. RESULTS: The mean age of the study group was 52.5 years (91% were men). Most patients had advanced HF. During a 6-month follow-up, 21 primary endpoints and 63 secondary endpoints were recorded. A multiple regression analysis showed that of all laboratory variables and biomarkers, only uric acid and sodium were independent predictors of primary endpoints, and only estimated glomerular filtration rate had a predictive value for secondary endpoints. None of the biomarkers were a significant prognostic factor in the study population. CONCLUSIONS: Biomarkers do not outweigh the value of standard laboratory tests. Routine laboratory workup allows to assess multiorgan damage and provides the most significant prognostic data. Biochemical tests should remain the gold standard for the assessment of prognosis in patients with HF.