Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
J Card Fail. 2019 Dec;25(12):948-958. doi: 10.1016/j.cardfail.2019.06.011. Epub 2019 Jul 2.
Young-adult heart transplant recipients transferring to adult care are at risk for poor health outcomes. We conducted a pilot randomized controlled trial to determine the feasibility of and to test a transition intervention for young adults who underwent heart transplantation as children and then transferred to adult care.
Participants were randomized to the transition intervention (4 months long, focused on heart-transplant knowledge, self-care, self-advocacy, and social support) or usual care. Self-report questionnaires and medical records data were collected at baseline and 3 and 6 months after the initial adult clinic visit. Longitudinal analyses comparing outcomes over time were performed using generalized estimating equations and linear mixed models.
Transfer to adult care was successful and feasible (ie, excellent participation rates). The average patient standard deviation of mean tacrolimus levels was similar over time in both study arms and < 2.5, indicating adequate adherence. There were no between-group or within-group differences in percentage of tacrolimus bioassays within target range (> 50%). Average overall adherence to treatment was similarly good in both groups. Rates of appointment keeping through 6 months after transfer declined over time in both groups.
The feasibility of the study was demonstrated. Our transition intervention did not improve outcomes.
从青少年期过渡到成人期接受心脏移植的患者存在健康状况不佳的风险。我们开展了一项试点随机对照试验，旨在确定针对曾接受儿童心脏移植、随后转入成人护理的年轻人的过渡干预措施是否可行，并对其进行测试。
参与者被随机分配至过渡干预组（为期 4 个月，重点关注心脏移植知识、自我护理、自我倡导和社会支持）或常规护理组。在初始成人就诊后的基线、3 个月和 6 个月收集自我报告问卷和病历数据。使用广义估计方程和线性混合模型对随时间推移的结局进行纵向分析。
向成人护理的过渡是成功且可行的（即，参与率很高）。在研究臂中，他克莫司平均水平的患者标准差在整个时间内相似且<2.5，表明依从性良好。在目标范围内（>50%）的他克莫司生物测定的百分比方面，两组之间或组内均无差异。两组的总体治疗依从率均相似良好。两组在转移后 6 个月内的预约保持率随时间推移而下降。
研究的可行性得到了证明。我们的过渡干预并未改善结局。
