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Heart Transplant (HT) patients need complex drug treatment for life: many drugs and several daily doses (usually 5 times a day). This complexity may make it difficult to adhere to the treatment, which is key to therapeutic success. In order to facilitate medication preparation, a Weekly Multi-Dose Pillbox (WMDP-5), 5 doses/day, was designed in our HT program. The aim is to assess the improvement in adherence and satisfaction with the use of the WMDP-5 within a multifactorial intervention. Prospective single-center study started in April 2019. All HT patients were invited to participate. The multilevel intervention included the provision of the WMDP-5 as well as a training session with a specific video and information leaflets. The study was approved by regional ethics committee. To evaluate adherence, the Spanish version of BAASIS (Basel Assessment of Adherence with Immunosuppressive Medication Scale) Patient Questionnaire Interview and the Simplified Medication Adherence Questionnaire (SMAQ) were used at delivery and at the follow-up visit. A Likert Scale (1-5) evaluate satisfaction at the follow-up visit (the next one to the center ≥ 1 months after using the WMDP). Patients with the follow-up visit until October 2019 were analyzed. A total of 214 HT patients (mean age 61,8±12,89 years, 79,4% males, with mean time after HT of 9,86±6,9 years) were included in the analysis. The highest level of education was primary school in 45,3%, 67,3% were married and 85% lived with someone. According to the SMAQ, there were 156/214 (72.89%) adherents at baseline and 193/214 (90,2%) at follow-up visit (p=0.006). Of 58 non-adherent patients at the baseline visit, 47 (81%) were adherent (improved) at the follow-up visit; while of 156 adherents at the basal visit, only 10 (6,4%) became non-adherents (worsened). The BAASIS questionnaire documented an overall improvement. Thus, the fist BAASIS question (if any pill was forgotten) at the baseline visit was 8%, while at the follow-up visit was 1,7%. Finally, according to the Likert Scale, 71,5% of the patients responded that the WMDP-5 helped them to take the treatment well. The use of a WMDP-5 in the context of a multilevel intervention improves therapeutic adherence in HT patients. It should be noted that this improvement occurs in a cohort of HT patients with already high adherence. [ABSTRACT FROM AUTHOR]

End-stage heart failure (HF) is often associated with malnutrition and sarcopenia, both of them are related to adverse HF outcomes. Skeletal muscle mass and attenuation are predictors of mortality after continuous flow left ventricular devices (LVAD) implantation. Our purpose was to assess the prognostic impact of skeletal muscle mass on patients undergoing heart transplantation (HT). Retrospective study of a single-center HT population, between 2009 and 2019. Patients > 18 years-old with a computed chest scan in the previous 6 months before HT were included. Multiorgan transplants were excluded. Unilateral pectoralis muscle mass indexed (PMMi) to body surface area and attenuation (by mean Hounsfield units [PHUm]) were measured in each patient. HT patients were classifiedin tertiles according to PMMi and PHUm and characteristics of patients were compared by Chi-square, t-student and Kruskall-Wallis. Multivariate Cox regression analyses were performed to assess the impact of preoperative PMMi and PHUm on survival after HT. 132 patients were included, mean age 58.9, 16.7% female, median follow-up 3.67 years (interquartile range 1.7-5.9 years). 41.7% of patients underwent urgent HT (1.5% INTERMACS 1 situation, 15.2% INTERMACS 2 and 28% INTERMACS 3). Both PMMi and PHUm were lower in females and for lowest weight recipients. Urgent HT frequency was similar between tertiles of PMMi, but recipients in the higher tertile of PHUm were more frequently transplanted in an urgent status (38.2% vs 21.8% in the lowest tertile, p= 0.029). 26 patients (19.7%) died during follow-up, 12 (9.1% of total cohort) during HT admission. In the Cox regression analyses, neither PMMi (HR 1.034, 95% CI 0.891-1.2, p= 0.659) nor PHUm (HR 1.02, 95% CI 0.992-1.050, p=0.160) were associated with an increased mortality. Only the needed of mechanical circulatory support and hemofiltration after HT were associated with a higher risk of death. Among this single-center HT recipients population, neither lower PMMi nor lower PHUm were associated with worse outcomes after HT. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: It has been suggested that for adequate maintenance of tacrolimus levels, the total daily dosage should be increased when switching from the conventional twice-daily regimen tacrolimus (CT) to once-daily sustained-release tacrolimus (SR-T). Objective: To evaluate the safety and efficacy of a 25% increase in daily dosage when switching heart transplant (HT) patients from CT to SR-T. Methods: We switched 75 HT patients including 72% males and an overall mean age of 55.6 years from CT to SR-T using a 25% increase in daily dosage. We screened for adverse events by measurements of lipids, creatinine, glycemia, and tacrolimus in blood samples taken at 1, 3, 7, and 12 weeks after the conversion, as well as by repeated echocardiography and routine clinical examinations. Results: Just two patients (2.7%) were returned to CT because of failure of SR-T to attain therapeutic levels. In the remainder of subjects, tacrolimus levels remained stable, with trough values of 8.7 ± 3.2, 8.7 ± 2.9, 8.3 ± 2.6, and 7.5 ± 2.0 mg/dL, respectively. Twenty-three patients (31%) required no dosage change in the first 3 months, but 44 (33%) required one or two changes. No departure from therapeutic levels was associated with rejection; there was no case of severe intercurrent infection. We did not observe significant changes in glycemia, creatinine, lipid profile, or blood pressure. Conclusions: Administration of SR-T at a dosage 25% higher than the daily dosage of CT was safe. It ensured adequate tacrolimus levels in one-third of patients. Nevertheless, strict analytical surveillance is necessary during the initial months to allow dosage adjustments and to detect the minority of patients for whom SR-T does not achieve therapeutic tacrolimus levels. [ABSTRACT FROM AUTHOR]