443: Social Isolation and Depression as Predictors of 12 Month Outcomes in the Waiting for a New Heart Study

The role of the Heart Failure Survival Score and psychosocial stress in predicting event-free survival in patients referred for heart transplantation

We read with interest the article “Selecting patients for heart transplantation: Comparison of the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM)” by Goda et al. Their study showed that the HFSS and the SHFM are similarly predictive of event-free survival in heart transplant (HTx) candidates enrolled at a single center in the USA. We also found that a HFSS denoting high medical risk predicts time until death, urgent transplantation, and implantation of ventricular assist devices (VAD) in patients newly listed for an HTx with Eurotransplant; in that same study, we have also shown that low HFSS risk predicts de-listing due to clinical improvement. The article b…

Behavioural Cardiology at the Department of Psychology, Johannes Gutenberg-University Mainz, Germany

Abstract. We provide a short overview of the research in Behavioural Cardiology at the Department of Psychology at the Johannes Gutenberg-University Mainz focussing on two lines of research: Studies of psychosocial variables that might enhance or attenuate cardiovascular risk in healthy individuals and studies of psychosocial variables and health behaviours that might impact the health status of patients listed for heart transplantation. Our studies so far suggest that psychosocial factors like anxiety and repressive coping impact information processing and cardiovascular responses to stress. Moreover, we examine the impact of health-protective resource variables including self-efficacy an…

Psychosoziale Aspekte und Gesundheitsverhalten bei Herzinsuffizienz

Zusammenfassung. Für die steigende Zahl von Patienten mit Herzinsuffizienz stehen verschiedene medizinische Behandlungsansätze zur Verfügung, darunter als letzte Option die Herztransplantation (HTX). Ergänzende psychosoziale und behaviorale Interventionen erscheinen aus verschiedenen Gründen auch für Patienten auf der HTX-Warteliste sinnvoll. Unser Literaturüberblick zeigt, dass bekannte psychosoziale koronare Risikofaktoren wie Depressivität und soziale Isolation auch bei Herzinsuffizienz Morbidität und Mortalität erhöhen. Körperliche Aktivität wirkt sich dagegen günstig auf subjektive und objektive Parameter aus. Diese Faktoren stellen erste Ansatzpunkte für verhaltensorientierte Interve…

Depression and disease severity as correlates of everyday physical activity in heart transplant candidates

Summary It is unclear to what extent patients awaiting heart transplantation (HTx) engage in physical activities. We examined the everyday physical activity and its associations with depressive symptoms and disease severity in 318 patients newly registered for HTx in the multi-site study ‘Waiting for a New Heart’ (aged 53.5 ± 11.4 years, 18% female patients). Participants completed questionnaires assessing depressive symptomatology and physical activity (number of physical activities, caloric expenditure associated with each activity), and estimated the distance they were able to walk without a break. Medical parameters at the time of listing [e.g. peak oxygen consumption (peakVO2); the Ger…

Social support group attendance is related to blood pressure, health behaviours, and quality of life in the Multicenter Lifestyle Demonstration Project

Changes in coronary risk factors, health behaviours, and health-related quality of life (HRQOL) were examined by tertiles of social support group attendance in 440 patients (21% females) with coronary artery disease. All patients participated in the Multicenter Lifestyle Demonstration Project (MLDP; eight hospital sites in the USA), an insurance-covered multi-component cardiac prevention program including dietary changes, stress management, exercise and group support for 1 year. Significant improvements in coronary risk factors, health behaviours, and HRQOL were noted at 1 year. Several of these improvements (i.e. systolic blood pressure, health behaviours, HRQOL) were related to social sup…

Composite risk scores and depression as predictors of competing waiting-list outcomes: the Waiting for a New Heart Study

We evaluated two composite risk scores, (Heart Failure Survival Score, HFSS; German Transplant Society Score, GTSS), and depression as predictors of mortality and competing waiting-list outcomes [high-urgency transplantation (HU-HTx), elective transplantation, delisting because of clinical improvement] in 318 heart transplant (HTx) candidates (18% women; aged 53 ± 11 years) from 17 hospitals and newly registered with Eurotransplant. Demographic variables and depression (Hospital Anxiety and Depression Scale, HADS) were assessed using questionnaires. Variables to compute HFSS and GTSS, age, medications, and outcomes were provided by Eurotransplant. At 12 months, 33 patients died, 83 received…

The effects of academic stress on health behaviors in young adults

Abstract The present study examined changes in health behaviors as a function of academic stress. One-hundred and thirty-three college undergraduate students completed measures of stress, affect, and health-behaviors during times of low and high academic demands. During the high-stress period, negative affect increased and positive affect decreased significantly, while health behaviors deteriorated. The strongest decrements were observed for exercise. Generally, women scored higher on “routine health behaviors” (i.e., self-care, vehicle safety, drug avoidance), but not on behaviors requiring effort (i.e., exercise, healthy nutrition). Distinct patterns of changes in health behaviors and aff…

286: Waiting for a new heart: Early experience from a prospective multi-site study of psychosocial and medical predictors of pre-transplant outcomes

370: Physical activity in patients newly listed for heart transplantation: Results from the “Waiting for a New Heart Study”

Psychological Characteristics and Social Integration of Patients with Ischemic and Non-Ischemic Heart Failure Newly Listed for Heart Transplantation: The Waiting for a New Heart Study

It is not known whether psychosocial risk factors for coronary artery disease (CAD) are present in patients listed for heart transplantation (HTx). The aim of this study was to examine whether HTx candidates with ischemic heart failure (due to CAD) have an adverse psychological risk profile and reduced social integration compared to patients with non-ischemic etiology. In the multi-site study "Waiting for a New Heart", waiting-list-related stressors, depression, anxiety, trait-anger, anger-expression, dispositional coping, social integration, and social support were assessed in 318 newly registered HTx candidates (53.5 ± 11.4 years, 18% female, left ventricular ejection fraction <25%). Medi…

Psychosocial and behavioural factors in heart transplant candidates--an overview.

Mortality among heart transplant (HTX) candidates remains high. This review of the literature shows that psychosocial characteristics like depression, social isolation and coping strategies contribute to morbidity and mortality in heart failure (HF) patients, and may also be relevant to the prognosis of HTX candidates. Based on the research to date, physical activity favourably affects subjective and objective parameters not only in HF patients, but also in HTX candidates. Depression is prevalent among HTX candidates, especially in ischaemic patients, and seems to be related to earlier transplantation. Findings on the effects of depression on pretransplant mortality are conflicting. Not muc…

Social isolation and depression predict 12-month outcomes in the "waiting for a new heart study".

Identification of modifiable psychosocial characteristics related to survival of heart transplant (HTx) candidates is needed to prevent clinical deterioration and improve prognosis.A multi-site, prospective study was conducted with 318 HTx candidates (18% female, 82% male; 53 +/- 11 years of age) newly listed at 17 hospitals in Germany and Austria. Baseline demographic and psychosocial characteristics were assessed by questionnaires. Indicators of disease severity (Heart Failure Survival Score, creatinine, cardiac index) and 12-month outcomes (death, high-urgency HTx, elective HTx, de-listing due to deterioration or improvement) were provided by Eurotransplant.By 12 months, 33 patients died…

Prognosis of Patients Listed for a Heart Transplant During the Pretransplant Period: Does Diabetes Matter?

Whether patients with advanced heart failure and diabetes mellitus (DM) should be listed for heart transplantation (HTx) remains controversial due to conflicting findings regarding their post-HTx survival (1–3). We studied HTx candidates with and without DM during the pre-HTx period, examining multiple waiting list outcomes. Patients were enrolled in the Waiting for a New Heart Study, a multisite observational study of 318 adult (≥18 years of age) patients (aged 53 ± 11 years; 18% female) who were newly listed for HTx with Eurotransplant between April 2005 and December 2006 (4). Informed consent and ethics approval were obtained (4). Characteristics at the time of listing included age, DM, …

Emotional correlates of body weight: The moderating effects of gender and family income

Abstract This study explored emotional correlates of relative body weight in a sample of 187 male and 269 female college students. The contribution of relative body weight, gender, family income and their interactions to variables related to anxiety and anger were evaluated by multiple regression procedures. Relative body weight was positively related to trait anxiety, especially among those with lower family incomes. Increased body weight was also related to trait anger and an anger-out expression style, but only among men. These results suggest that gender and family income moderate the contribution of relative body weight to anxiety and anger, both central aspects of a 'disease-prone per…

Emotions and Cardiovascular Disease

Dietary habits are related to outcomes in patients with advanced heart failure awaiting heart transplantation.

Abstract Background Empirical evidence supporting the benefits of dietary recommendations for patients with advanced heart failure is scarce. We prospectively evaluated the relation of dietary habits to pre-transplant clinical outcomes in the multisite observational Waiting for a New Heart Study. Methods and Results A total of 318 heart transplant candidates (82% male, age 53 ± 11 years) completed a Food Frequency Questionnaire (foods high in salt, saturated fats, poly-/monounsaturated fats [PUFA+MUFA], fruit/vegetables/legumes, and fluid intake) at time of waitlisting. Cox proportional hazard models controlling for heart failure severity (eg, Heart Failure Survival Score, creatinine) estim…

221 Better Event-Free Survival in Ambulatory Heart Transplant (HTx) Candidates Who Are Physically Active and in Good Mood

(pre-Group1 89.6 6.1 x pre-Group2 89.3 6.9, p 0.8; 1yr97.6 1.1 x 97.1 1.5, p 0.3; 2yr96.8 2.3 x 97.0 1.1,p 0.9,in %); MIP (pre64.0 23.9 x 65.5 24.2, p 0.8; 1yr94.9 25.2 x 98.5 15.6, p 0.7; 2yr93.4 26.6 x 101.3 12.6, p 0.7) and MEP (pre-92 29.1 x 86.5 27.1, p 0.5; 1yr 99.2 28.5 x 104.9 16.4,p 0.9; 2yr 103.14 25 x 105.6 16.4, p 0.7,in cmH2O) and 6MWT (pre-428 137.4 x 411.2 113.9, p 0.5; 1yr 629.2 91.26 x 659.2 93.5, p 0.3; 2yr 645.9 91.5 x 686.6 98.6, p 0.2,in meters). Conclusions: Our findings indicate that unsupervised rehabilitation may represent an alternative in the management of post lung transplant patients.

593: Gender Differences in One-Year Waiting List Outcomes in Heart Transplant Candidates: Results from the Waiting for a New Heart Study

484 Depression Reduces Chance for Clinical Improvement in Heart Transplant Candidates Independent of Disease Severity, Physical Activity and Eating Habits

Avoidant coping style and verbal-cardiovascular response dissociation

Abstract This study explored the relationship between an avoidant coping style and three responses during three experimental periods (i.e., speech preparation, speech delivery, and recovery). One response was cardiovascular reactivity, the two other responses were subjective in nature: self-reports of anxiety and self-estimations of blood pressure. Subjects were 20 male and 20 female students who scored either in the upper third (i.e., high-avoiders) or lower third (i.e., low-avoiders) on cognitive avoidance (Krohne, 1989). When compared to subjects scoring low on avoidance, those high on avoidance showed greater systolic blood pressure (SBP) reactivity and evidenced verbal-autonomic respon…

162 Medical and Psychosocial Predictors of Mechanical Circulatory Support Device Implantation in the Waiting for a New Heart Study

Patients' sex and emotional support as predictors of death and clinical deterioration in the Waiting for a New Heart Study: results from the 1-year follow-up

Context—Little is known about the role of patient's sex and emotional support in the prognosis of heart transplant candidates.Objective—To examine patient's sex and emotional support as predictors of outcomes in the Waiting for a New Heart Study.Design, Setting, and Participants—The Waiting for a New Heart Study is a prospective observational study of 318 patients (18% female) newly added to the waiting list for a heart transplant. Demographic, medical, psychosocial characteristics (including social support [ENRICHD Social Support Index; high vs low support]) were assessed at the time of wait-listing.Main Outcomes—Time until death/delisting due to deteriorated health, considering competing …