The international prevalence and variability of nonadherence to the nonpharmacologic treatment regimen after heart transplantation: Findings from the cross-sectional BRIGHT study

Helmy R.; Duerinckx N.; De Geest S.; Denhaerynck K.; Berben L.; Russell C. L.; Van Cleemput J.; Crespo-Leiro M. G.; Dobbels F.; Cupples S.; De Simone P.; Groenewoud A.; Kugler C.; Ohler L.; Poncelet A. J.; Sebbag L.; Michel M.; Bernard A.; Doesch A.; Livi U.; Manfredini V.; Brossa-Loidi V.; Segovia-Cubero J.; Almenar-Bonet L.; Saint-Gerons C. S.; Mohacsi P.; Horvath E.; Riotto C.; Parry G.; Firouzi A.; Kozuszko S.; Haddad H.; Kaan A.; Fisher G.; Miller T.; Flattery M.; Ludrosky K.; Albert N.; Coleman B.; Trammell J.; St. Clair K.; Kao A.; Molina M.; Canales K. R.; de Almeida S. S.; Cotait Ayoub A.; Barone F.; Harkess M.; Maddicks-Law J.

The international prevalence and variability of nonadherence to the nonpharmacologic treatment regimen after heart transplantation: Findings from the cross-sectional BRIGHT study

Helmy R.

•

Duerinckx N.

•

De Geest S.

altro

Maddicks-Law J.

2018

journal article

Periodico

CLINICAL TRANSPLANTATION

Abstract

Introduction: Heart transplant (HTx) recipients need to follow a complex therapeutic regimen. We assessed the international prevalence and variability in nonadherence to six nonpharmacologic treatment components (physical activity, sun protection, diet, alcohol use, nonsmoking, and outpatient follow-up visits). Methods: We used self-report data of 1397 adult HTx recipients from the 36-HTx-center, 11-country, 4-continent, cross-sectional BRIGHT study (ClinicalTrials.gov ID: NCT01608477). The nonadherence definitions used were as follows: Physical activity: <3 times/wk 20 minutes’ vigorous activity, <5 times/wk 30 minutes’ moderate activity, or <5 times/wk a combination of either intensity; Sun protection: not “always” applying any sun protection; Diet: not “often” or “always” following recommended diet(s); Alcohol use: >1 alcoholic drink/d (women) or >2 drinks/d (men); Smoking: current smokers or stopped <1 year before; Follow-up visits: missing ≥1 of the last 5 outpatient follow-up visits. Overall prevalence figures were adjusted to avoid over- or underrepresentation of countries. Between-country variability was assessed within each treatment component via chi-square testing. Results: The adjusted study-wide nonadherence prevalence figures were as follows: 47.8% for physical activity (95% CI [45.2-50.5]), 39.9% for sun protection (95% CI [37.3-42.5]), 38.2% for diet recommendations (95% CI [35.1-41.3]), 22.9% for alcohol consumption (95% CI [20.8-25.1]), 7.4% for smoking cessation (95% CI [6.1-8.7]), and 5.7% for follow-up visits (95% CI [4.6-6.9]). Significant variability was observed between countries in all treatment components except follow-up visits. Conclusion: Nonadherence to the post-HTx nonpharmacologic treatment regimen is prevalent and shows significant variability internationally, suggesting a need for tailored adherence-enhancing interventions.