Variations in psychological adaptation to prescribed heart transplantation: long-term risk factors and survival probability / Variations in Psychological Adaptation to Prescribed Heart Transplantation - Long-Term Risk Factors and Survival Probability

RESUMO

BACKGROUND: The criteria for psychosocial screening of candidates to heart trasnplant are still arguable,in view of difficulties in collecting cumulative data as a result of the high death rate of candidates to the procedure and methodological discontinuity between preliminary diagnostic tools and those who assess the outcomes of this medical procedure in the long term. METHODS: An adaptive scale (AODS) was applied indata from short term psychotherapy carried out with 221 candidates to heart transplant,as from initial prescription to the procedure. data was obtained form October 1991 until March 1999. The qui-square test was used in the statistical analysis of results. Survival tables were calculated according to the Kaplan-Meier method. The Logrank test was applied in curve comparison and a=0,05 sigificance level was used. RESULTS: Eigth different groups wuere identifield and characterized by a set of emotional responses,attitudes and feelings towards heart transplant prescription. These groups proved to be od predictive value for long term adaptation,and werw associated to cumulative survival probability, as regards statistical significance. CONCUSION In most cases, there is resilence to accepting heart transplant. Patients respond to the prescribed procedure mostly under defense mechanisms wich act as natural selection to the procedure. Participation and quality of family relationships are crucial to the success of the procedure, and should be value nearly as much as any individual psycho-pathological condition. Based on this approach, its is possible to screem cases wich show difficulties related to the chronic disease,fromthose wich present adaptive inefficacy, preventing therefore engagement with the treatment and requiring specific therapy.