Perfil alimentar de transplantados cardíacos de um centro transplantador brasileiro - Atuação da enfermagem neste cenário / Perfil alimentario de los trasplantes de corazón en un centro de trasplante brasileño - Desempeño de la enfermería en este escenario / Food profile of heart transplants in a brazilian transplantation center - Nursing performance in this scenario

Objetivo- Descrever o perfil alimentar de pacientes pós transplante cardíaco (TC) tardio de um centro transplantador brasileiro. Método- Estudo observacional transversal com delineamento descritivo. O estudo ocorreu em uma instituição de ensino público de Minas Gerais. A coleta de dados ocorreu no período de 2017 a 2019. Resultados-. A amostra do estudo foi composta por 62 indivíduos transplantados entre os anos de 2006 a 2016. Aproximadamente 63% era do sexo masculino. A média de idade foi de 46,53 anos. O consumo de carboidratos e gorduras foi adequado em 46,77% e 59,68% da amostra, respectivamente. Já o consumo de proteínas foi acima do recomendado em 77,42% e o consumo de fibras abaixo do recomendado em 79,03%. Conclusão- Houve a predominância do sexo masculino. Os indivíduos apresentaram um consumo adequado somente de carboidratos e gorduras. Não houve na literatura estudos descrevendo a atuação do enfermeiro no processo de nutrição neste cenário(AU)

Objective- To describe the dietary profile of patients after late heart transplantation (HT) from a Brazilian transplant center. Method- Cross-sectional observational study with descriptive design. The study took place in a public education institution in Minas Gerais. Data collection took place from 2017 to 2019. Results-. The study sample consisted of 62 individuals transplanted between 2006 and 2016. Approximately 63% were male. The mean age was 46.53 years. The consumption of carbohydrates and fats was adequate in 46.77% and 59.68% of the sample, respectively. The consumption of proteins was above the recommended in 77.42% and the consumption of fibers below the recommended in 79.03%. Conclusion- There was a predominance of males. The individuals presented an adequate consumption of only carbohydrates and fats. There were no studies in the literature describing the role of nurses in the nutrition process in this scenario(AU)

Objetivo- Describir el perfil dietético de pacientes después de un trasplante cardíaco (TC) tardío de un centro de trasplante brasileño. Método- Estudio observacional transversal con diseño descriptivo. El estudio se llevó a cabo en una institución de educación pública en Minas Gerais. La recolección de datos se llevó a cabo de 2017 a 2019. Resultados-. La muestra del estudio estuvo compuesta por 62 individuos trasplantados entre 2006 y 2016. Aproximadamente el 63% eran hombres. La edad media fue de 46,53 años. El consumo de carbohidratos y grasas fue adecuado en el 46,77% y 59,68% de la muestra, respectivamente. El consumo de proteína estuvo por encima del nivel recomendado en un 77,42% y el consumo de fibra por debajo del nivel recomendado en un 79,03%. Conclusión- Hubo predominio del sexo masculino. Los individuos presentaron un consumo adecuado de solo carbohidratos y grasas. No hubo estudios en la literatura que describieran el papel del enfermero en el proceso de nutrición en este escenario.(AU)

Brief Overview of Lung, Heart, and Heart-Lung Transplantation.

Lung transplantation, heart transplantation, and heart-lung transplantation are life-saving treatment options for patients with lung and/or cardiac failure. Evolution in these therapies over the past several decades has led to better outcomes with application to more patients. The complexity and severity of illness of patients in the pretransplant phase has steadily increased, making posttransplant intensive care unit management more difficult. Despite these factors and the pervasive complications of immunosuppressive therapy, outcomes continue to improve.

Perioperative Management of the Cardiac Transplant Recipient.

Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management to achieve an optimal outcome. Primary graft dysfunction (PGD) can be an ominous problem after cardiac transplantation. Although mild degrees of PGD may be managed medically, mechanical circulatory support with extracorporeal membrane oxygenation or temporary ventricular assist devices may be required. Retransplantation may be necessary in some cases.

Renal Complications Following Lung Transplantation and Heart Transplantation.

Renal complications are common following heart and/or lung transplantation and lead to increased morbidity and mortality. Renal dysfunction is also associated with increased mortality for patients on the transplant wait list. Dialysis dependence is a relative contraindication for heart or lung transplantation at most centers, and such patients are often listed for a simultaneous kidney transplant. Several factors contribute to the impaired renal function in patients undergoing heart and/or lung transplantation, including the interplay between cardiopulmonary and renal hemodynamics, complex perioperative issues, and exposure to nephrotoxic medications, mainly calcineurin inhibitors.

Infections in Heart and Lung Transplant Recipients.

Infections in heart and lung transplant recipients are complex and heterogeneous. This article reviews the epidemiology, risk factors, specific clinical syndromes, and most frequent opportunistic infections in heart and/or lung transplant recipients that will be encountered in the intensive care unit and will provide a practical approach of empirical management.

Assistência de enfermagem ambulatorial: percepção de transplantados cardíacos sobre a consulta de enfermagem ambulatorial / Atención ambulatoria de enfermería: percepción de los trasplantados cardiacos acerca de la consulta de enfermería ambulatoria / Outpatient nursing care: perception of the heart transplant patients onoutpatient nursing consultation

Objetivo: conhecer a percepção de transplantados cardíacos em relação à consulta de enfermagem em um ambulatório na Unidade de Transplante e Insuficiência Cardíaca (UTIC). Método: Estudo descritivo, de abordagem qualitativa, realizado na UTIC de um hospital público, localizado em Fortaleza, Ceará, de julho a novembro de 2013, com 11 pacientes transplantados cardíacos. Os discursos foram obtidos por meio da entrevista teóricos da hermenêutica. Resultados: Os pacientes revelaram o impacto sofrido pelo transplante cardíaco e satisfação no acolhimento pelos profissionais, em especial a enfermeira. Expressaram o reconhecimento das orientações prestadas, das modificações estabelecidas nesse processo e do vínculo entre enfermeira-paciente. Conclusão: Os transplantados cardíacos compreenderam que a enfermeira age de forma humanizada, acolhedora, cria vínculos e promove o autocuidado, a fim de garantir melhorias na saúde, por meio da consulta de enfermagem ambulatorial.

Objective: this study aimed to know the perception of cardiac transplanted in relation to nursing consultation at a clinic in Transplant and Heart Failure Unit (UTIC). Method: Descriptive study of qualitative approach, conducted in UTIC of a public hospital, located in Fortaleza, Ceará, from July to November 2013, with 11 heart transplant patients. The discourses were collected through a semi structured interview and organized according to the theoretical principles of hermeneutics. Results: Patients showed the impact suffered by the heart transplant and satisfaction in welcoming the professionals, especially the nurse. Were expressed the recognition of the provided guidelines, the changes set out in this process and the relations between nurses and patients. Conclusion: The heart transplant understood that the nurse acts humanized, warmly, creates relations and promotes your own care to ensure improvements in health, through the outpatient nursing consultation.

Objetivo: el trabajo tuvo como objetivo conocer la percepción de pacientes trasplantados de corazón en relación a la consulta de enfermería en un Ambulatorio en la Unidad de Trasplante y Insuficiencia Cardíaca (UTIC). Método: Estudio descriptivo, con un abordaje cualitativo, realizado en la UTIC de un hospital público, localizado en Fortaleza, Ceará, de julio a noviembre de 2013, con 11 pacientes trasplantados cardíacos. Los discursos fueron obtenidos a través de una entrevista semi estructurada y organizados según los fundamentos teóricos de La hermenéutica. Resultados: Los pacientes mostraron el impacto sufrido por el trasplante de corazón y la satisfacción de la bien venidade lós profesionales, especialmente a la enfermera. Expresaron reconocimiento de las directrices, de los cambios establecidos en el proceso y de la relación entre la enfermera y el paciente. Conclusión: El trasplantado de corazón entiende quela enfermera actúa de una manera humana, con gusto, CREA vínculos y promueve el auto cuidado para garantizar mejoras en la salud, a través de la consulta ambulatoria de enfermería.

Clinical care of nursing reasoned in Parse: contribution in the transcendence process of cardiac transplantation. / Cuidado clínico de enfermagem fundamentado em Parse: contribuição no processo de transcendência de transplantados cardíacos.

OBJETIVO: To identify how the clinical and educational nursing care based on the Theory of Human Becoming can contribute to the transcendence process of heart transplant patients in pursuit of good living. METHOD: Research-intervention developed with four heart transplant patients linked to a reference transplant hospital in Ceara. Data was collected through interviews in 2014 and analyzed using Parse's theoretical framework and pertinent literature. RESULTADOS: Transplant patients revealed they gave living in such condition an ambiguous meaning, showing satisfaction and dissatisfaction. Dietary restrictions, difficulties with medication and curiosity about the transplant were identified as disharmonies involving the process. Care was developed focused on educating the transplant patients, approaching the themes healthy eating, organ rejection, immunosuppressant use and facts about heart transplantation. CONCLUSION: Educative care based on Parse favors the decision-making and autonomy of individuals regarding their health, contributing to transcendence in pursuit of good living.

Maintaining the Gift of Life: Achieving Adherence in Adolescent Heart Transplant Recipients.

Since the beginning of United Network of Organ Sharing data collection in 1987, a total of 8,333 pediatric patients have received a heart transplant in the United States. Because these patients now have longer graft success with improved care and immunosuppression, many of them are entering adolescence and young adulthood. Primary care pediatric nurse practitioners need to be alert to the prevalence of noncompliance with treatment in heart transplant patients, which continues to be highest in adolescence. Low compliance in adolescence increases morbidity, contributes to decreasing quality of life, and is the leading reason for graft failure and mortality in this age group. This article will review common barriers to treatment adherence in the adolescent heart transplant patient, discuss the role of the primary care pediatric nurse practitioner in preventing noncompliance, and review strategies that the primary care pediatric nurse practitioner can implement to improve compliance in this patient population.

The experiences of heart transplant recipients' spouses during the pretransplant waiting period: integrative review.

AIMS AND OBJECTIVES: To explore the experiences of spouses of heart transplant recipients and to consider how an understanding of these experiences may inform nursing practice. BACKGROUND: There is a lack of knowledge about the experiences of spouses of heart transplant recipients during the pretransplant wait. Evidence suggests that spousal support improves post-transplant outcomes of heart transplant recipients; therefore, it is important to understand how nurses can improve spouses' psychological well-being during the pretransplant wait. DESIGN: Integrative review. METHOD: A search of six electronic databases between November 2015-December 2015 and a hand search yielded 510 citations; nine studies met the review eligibility criteria. Inclusion criteria were applied to selected studies for review. Methodological quality of selected studies was evaluated, and data were extracted and compiled. RESULTS: Six themes were identified: uncertainty, thoughts about death, changes to lifestyle and priorities, loss of sense of self, quality of life and learning to cope. Spouses experience high levels of stress caused by uncertainty about the patient's survival, increased responsibilities and changes to their lifestyle. CONCLUSION: The results reveal that the pretransplant period is all-consuming for spouses of heart transplant recipients. The impact of the pretransplant wait on spouses' well-being should be recognised by nurses, and improvements must be made in support and education available to spouses during the pre-transplant period. RELEVANCE FOR CLINICAL PRACTICE: There is a need for improved education about the transplant process, and reinforcement of positive coping strategies.

Cuidado clínico de enfermagem fundamentado em Parse: contribuição no processo de transcendência de transplantados cardíacos / Cuidado clínico de enfermería fundamentado en Parse: contribución en el proceso de trascendencia trasplantados cardíacos / Clinical care of nursing reasoned in Parse: contribution in the transcendence process of cardiac transplantation

RESUMO Objetivo Identificar como os cuidados clínicos e educativos de enfermagem, fundamentados na Teoria Human Becoming, contribuem para o processo de transcendência das pessoas transplantadas cardíacas na busca do bem viver. Método Pesquisa-intervenção desenvolvida com quatro transplantados cardíacos vinculados a um Hospital de referência em transplantes do Ceará. Dados coletados em 2014, mediante entrevistas, analisados pelo referencial teórico de Parse e literatura pertinente. Resultados Os significados de viver como transplantado cardíaco revelaram ambiguidade, mostrando satisfação e insatisfação. Restrições alimentares, dificuldades com a medicação e curiosidade acerca do transplante foram apontadas como desarmonias que envolvem o processo. Visando a mobilização da transcendência, foi desenvolvido um cuidado educativo com os temas alimentação saudável, rejeição do órgão, uso de imunossupressores e curiosidades sobre o transplante cardíaco. Conclusão O cuidado educativo, fundamentado em Parse, favorece a tomada de decisão e a autonomia dos sujeitos diante de sua saúde, contribuindo para a transcendência na busca do bem viver.

RESUMEN Objetivo Identificar cómo los cuidados clínicos y educativos de enfermería, fundamentados en la Teoría Human Becoming, contribuyen para el proceso de trascendencia de las personas trasplantadas cardíacas en búsqueda del bien vivir. Método Investigación de intervención desarrollada con cuatro trasplantados de corazón vinculados a un hospital de referencia en trasplantes de Ceará. Los datos recogidos en el año de 2014 a través de entrevistas, analizaron el marco teórico de Parse y su literatura. Resultados El significado de la vida como trasplantado de corazón reveló ambigüedad, que muestra la satisfacción y la insatisfacción. Restricciones en la dieta, las dificultades con la medicación y la curiosidad por el trasplante fueron identificados como desarmonías relacionadas con el proceso. Objetivando la movilización de la trascendencia, se desarrolló atención educativa con temas sanos de alimentación, el rechazo del órgano, el uso de inmunosupresores y curiosidades sobre el trasplante de corazón. Conclusión Cuidado educativo, sobre la base de Parse, favorece la toma de decisiones y la autonomía de las personas delante de su salud, lo que contribuye a la trascendencia en búsqueda del bien vivir.

ABSTRACT Objetivo To identify how the clinical and educational nursing care based on the Theory of Human Becoming can contribute to the transcendence process of heart transplant patients in pursuit of good living. Method Research-intervention developed with four heart transplant patients linked to a reference transplant hospital in Ceara. Data was collected through interviews in 2014 and analyzed using Parse's theoretical framework and pertinent literature. Resultados Transplant patients revealed they gave living in such condition an ambiguous meaning, showing satisfaction and dissatisfaction. Dietary restrictions, difficulties with medication and curiosity about the transplant were identified as disharmonies involving the process. Care was developed focused on educating the transplant patients, approaching the themes healthy eating, organ rejection, immunosuppressant use and facts about heart transplantation. Conclusion Educative care based on Parse favors the decision-making and autonomy of individuals regarding their health, contributing to transcendence in pursuit of good living.

Balloon Pumps Inserted via the Subclavian Artery: Bridging the Way to Heart Transplant.

Intra-aortic balloon pumps have traditionally been inserted via the femoral artery, limiting patients' activity and exposing patients to complications of immobility. For patients awaiting cardiac transplant, these complications may threaten a successful outcome, or at the least, complicate recuperation after transplant. A novel approach to insertion of balloon pumps via the subclavian artery is presented here, including routine nursing care, complications and related nursing actions, and experience with and advantages of this method. A team approach to care of these patients, including rehabilitation and exercise protocols, is recommended.

Cardiac Transplant Postoperative Management and Care.

Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted.

Transplantados cardíacos em pós-operatório mediato: diagnóstico de enfermagem segundo pressupostos de Horta / Heart transplanted patients in mediate postoperative period: Nursing diagnoses based on Horta assumptions

Identificar o perfil dos diagnósticos de Enfermagem nos pacientes transplantados cardíacos em pós?operatório mediato, a partir da Taxonomia II da North?American Nursing Diagnosis Association, e discuti?los à luz dos pressupostos de Horta e da literatura científica. Método: Estudo retrospectivo, descritivo, exploratório, realizado em um hospital geral de grande porte de Belo Horizonte, em Minas Gerais. A amostra foi composta por 49 pacientes adultos, de ambos os sexos, idade ?18 anos e <60 anos, transplantados cardíacos em pós?operatório mediato. Os dados foram coletados a partir do prontuário do paciente. Resultados: Foram identificados 12 diagnósticos de Enfermagem, classificados em 10 reais e dois potenciais, sendo 100% pertencentes à necessidade humana básica psicobiológica. Conclusão: Não houve identificação diagnóstica para as necessidades psicossocial e psicoespiritual. Segundo Horta, o paradigma biologicista move a carreira à fragmentação do paciente, mantém o enfermeiro em alienação e opõe?se à pragmática centrada no holismo...

Cardiac Transplantation: Considerations for the Intensive Care Unit Nurse.

Heart transplantation is a recommended and curative treatment option for patients with advanced heart failure symptoms despite receiving optimal medical and device therapy. The availability of donor organs limits the number of patients able to receive a heart transplant. The overall outcome of patients able to receive a heart transplant is determined by the successful delivery of essential nursing care. Understanding the specific interventions and therapies unique to this patient population is critical to their care. This article reviews considerations for the intensive care unit clinician in the management of heart transplant patients in this setting.

The effectiveness of interventions in managing treatment adherence in adult heart transplant patients: a systematic review.

BACKGROUND: Over the past 20 years, solid organ transplantation has evolved from experimental treatments to an effective alternative for the treatment of various diseases, including heart failure. Treatment non-adherence is a limiting factor for the success of heart transplants. A systematic review of the evidence is needed to examine the effectiveness of interventions for managing adherence to treatment in heart transplant patients. OBJECTIVE: The primary objective of this systematic review was to synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart/heart-lung transplant patients. INCLUSION CRITERIA: This review considered primary studies that included patients 18 years old or older, who had undergone heart or heart-lung transplantation (regardless of gender, ethnicity, comorbidities or whether they had received other treatments or not) who were receiving pharmacological and non-pharmacological treatments.This review considered studies that evaluated the effectiveness of interventions in managing adherence to pharmacological or non-pharmacological treatments among adult heart/heart-lung transplant patients. Primary studies comparing standard care with any type of intervention to maintain treatment adherence were considered.This review considered any experimental study design including randomized controlled trials; other research designs, such as non-randomized controlled trials and before and after studies, were also considered for inclusion.The primary outcome considered was patient adherence to pharmacological or non-pharmacological treatments by means of objective or self-report assessment. SEARCH STRATEGY: Published and unpublished studies in English, Portuguese and Spanish were searched in electronic databases. Searches were completed in January 2014. METHODOLOGICAL QUALITY: Two independent reviewers, using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument, assessed methodological quality. DATA EXTRACTION: Data were extracted using the standardized data extraction tool from Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS: Statistical pooling was not possible due to substantial heterogeneity of the studies; therefore data were presented as a narrative summary. RESULTS: Three quasi-experimental studies were included in this review. One study found that a dose reduction of immunosuppressive medications from a twice-daily to a once-daily regimen had a positive impact on treatment adherence; one found no significant difference in treatment adherence between patients who received educational intervention conducted in a teaching laboratory and those who received standard care; the third one also reported no significant difference in outcomes between a multifaceted intervention consisting of internet-based interactive workshops and standard care. CONCLUSIONS: The current best evidence to guide decisions regarding interventions to manage treatment adherence in heart transplant patients is limited. There is weak evidence that psycho-educational interventions (other than the standard care) has a positive impact on adherence and that decreasing the complexity of the treatment regimen by reducing the daily dose of the immunosuppressant drug improves adherence in heart transplant patients.

Revisão integrativa sobre o transplante cardíaco pediátrico e os aspectos na qualidade de vida / Una revisión integradora acerca del trasplante cardiaco pediátrico y los aspectos en la calidad de vida / An integrative review about the pediatric heart transplant and the aspects of quality of life

Objective: It is an integrative review of literature that aims to review the productions concerning pediatric heart transplant and the aspects of quality of life, summarising the impact of transplantation in this group. Method: An integrative review, where there were elected descriptors; tested combinations; conducted a search in the databases; and thematic analysis to examining the findings. Results: The cutout of 68 studies reviewed, 23 were selected, among them only 10 were framed in all criteria, and were analyzed. Conclusion: The complex congenital heart diseases can be treated with heart transplantation in some stage of its evolution, without increased mortality or morbidity, evidenced in the fact that medical complications can be controlled.

Objetivo: Trata-se de uma revisão integrativa de literatura que objetiva revisar as produções referentes ao transplante cardíaco pediátrico e os aspectos na qualidade de vida, sintetizando o impacto do transplante neste grupo. Método: Revisão integrativa, onde foram eleitos descritores; testados combinações; realizada busca nas bases de dados e análise temática para examinar os achados. Resultados: Do recorte de 68 artigos pesquisados, foram selecionados 23, dentre eles apenas 10, se enquadravam em todos os critérios, e foram analisados. Conclusão: As cardiopatias congênitas complexas podem ser tratadas com o transplante cardíaco, em alguma fase de sua evolução, sem aumento da mortalidade ou morbidade, fato que evidenciamos nas complicações médicas passíveis de controle.

Objetivo: Es una revisión integral de la literatura que pretende revisar la producción relativa el transplante cardiaco pediátrico y los aspectos en la calidad de vida, resumiendo el impacto del trasplante en este grupo. Método: Revisión integradora, donde fueron elegidos los descriptores; probadas combinaciones; se realizó una búsqueda en las bases de datos; y el análisis temático para examinar los resultados. Resultados: Del corte de 68 artículos estudiados, 23 fueron seleccionados, entre ellos sólo 10 estaban enmarcados en los criterios, y se analizaron. Conclusión: Las cardiopatías congénitas complejas pueden ser tratadas con el trasplante de corazón en alguna etapa de su evolución, sin aumento de la mortalidad o la morbilidad, hecho que se evidencia en las complicaciones médicas que pueden ser controladas.

Adult cardiothoracic transplant nursing: an ISHLT consensus document on the current adult nursing practice in heart and lung transplantation.

BACKGROUND: The role of nurses in cardiothoracic transplantation has evolved over the last 25 years. Transplant nurses work in a variety of roles in collaboration with multidisciplinary teams to manage complex pre- and post-transplantation issues. There is lack of clarity and consistency regarding required qualifications to practice transplant nursing, delineation of roles and adequate levels of staffing. METHODS: A consensus conference with workgroup sessions, consisting of 77 nurse participants with clinical experience in cardiothoracic transplantation, was arranged. This was followed by subsequent discussion with the ISHLT Nursing, Health Science and Allied Health Council. Evidence and expert opinions regarding key issues were reviewed. A modified nominal group technique was used to reach consensus. RESULTS: Consensus reached included: (1) a minimum of 2 years nursing experience is required for transplant coordinators, nurse managers or advanced practice nurses; (2) a baccalaureate in nursing is the minimum education level required for a transplant coordinator; (3) transplant coordinator-specific certification is recommended; (4) nurse practitioners, clinical nurse specialists and nurse managers should hold at least a master's degree; and (5) strategies to retain transplant nurses include engaging donor call teams, mentoring programs, having flexible hours and offering career advancement support. Future research should focus on the relationships between staffing levels, nurse education and patient outcomes. CONCLUSIONS: Delineation of roles and guidelines for education, certification, licensure and staffing levels of transplant nurses are needed to support all nurses working at the fullest extent of their education and licensure. This consensus document provides such recommendations and draws attention to areas for future research.

Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study: study protocol.

AIM: This article describes the rationale, design and methodology of the Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study. This study of heart transplant patients will: (1) describe practice patterns relating to chronic illness management; (2) assess prevalence and variability of non-adherence to the treatment regimen; (3) determine the multi-level factors related to immunosuppressive medication non-adherence. BACKGROUND: The unaltered long-term prognosis after heart transplantation underscores an urgent need to identify and improve factors related to survival outcomes. The healthcare system (e.g. level of chronic illness management implemented) and patient self-management are major drivers of outcome improvement. DESIGN: The study uses a survey design in 40 heart transplant centres covering 11 countries in four continents. METHODS: Theoretical frameworks informed variable selection, which are measured by established and investigator-developed instruments. Heart transplant recipients, outpatient clinicians and programme's directors complete a survey. A staged convenience sampling strategy is implemented in heart transplant centres, countries and continents. Depending on the centre's size, a random sample of 25-60 patients is selected (N estimated 1680 heart transplant recipients). Five randomly selected clinicians and the medical director from each centre will be invited to participate. CONCLUSION: This is the first multi-centre, multi-continental study examining healthcare system and heart transplant centres chronic illness management practice patterns and potential correlates of immunosuppressive medication non-adherence. The knowledge gained will inform clinicians, researchers and healthcare policy makers at which level(s) interventions need to be implemented to improve long-term outcomes for transplant recipients.