P563Effects of tele-case-management program on the improvements of symptoms distress, and depressive symptoms in heart transplant recipients

Abstract

Background: Patients have to receive the heart transplantation when they have severe heart failure (NYHA Fc IV) without effective responses to medical therapy. Although patients may prolong their life after heart transplantation, they have to take immunosuppressive drugs lifelong. How to strike a balance between avoiding infection and preventing rejection causes patients both physiological and psychological distress. The tele‐health care could provide immediate care, and reduce the degrees of anxiety and depression for heart transplant recipients. Therefore, the purposes of this study were to develop the Tele‐Case‐Management Program, and determine its effects on the improvements of the symptom distress, and depressive symptom in heart transplant recipients. Method: This study used experimental design with pretest and post‐test. According to pretest of depression scores, we stratified and randomly assigned participants to the experimental group and control group. The heart transplant recipients in experimental group (n=31) received Tele‐Case‐Management Program intervention, and the recipients in control group (n=30) received the usual care. Each study participants was evaluated by Symptom Frequency and Symptom Distress Scale, Beck Depression Inventory‐II Scale, and Fatigue Scale at pretest, and one‐month and three‐month follow‐up. The generalized estimating equation (GEE) was used to examine the effects of the Tele‐Case‐Management Program on the improvements of symptom distress, and depressive symptoms. Results: The majority of participants were male (78.7%), with a mean age of 53.2±12.28 years, and mean ejection fraction (EF) after heart transplant of 61.74±10.04%. The participants receiving the Tele‐Case‐Management Program intervention showed significantly greater improvement than those in the control group in the symptom frequency (p=0.029, 0.001), symptom distress (p=0.014, 0.001), and depressive symptom (p=0.029, 0.001) at one‐month and 3‐month follow‐up. Conclusion: The Tele‐Case‐Management Program is able to improve symptom frequency and distress, and depressive symptoms in heart transplant recipients.