Prevalence and Risk Factors of Immunosuppressant Nonadherence in Heart Transplant Recipients: A Single-Center Cross-Sectional Study

Figures & data

Figure 1 The process of patient enrollment and exclusion during patient recruitment.

Table 1 Adherence to Immunosuppressants Measured by BAASIS-Written Questionnaire (N=168)

Dimension	BAASIS Items	Response	n (%)
Taking adherence	1: Do you remember missing a dose of your anti-rejection medications in the last 4 weeks?	Once	19 (11.3)
		Twice	4 (2.4)
		Three times	0 (0.0)
		Four times	0 (0.0)
		More than 4 times	0 (0.0)
			23 (14.0)
Drug holiday	2^a: Do you remember having skipped two or more doses of your anti-rejection medications in a row in the last 4 weeks?	Once	8 (4.8)
		Twice	0 (0.0)
		Three times	0 (0.0)
		Four times	0 (0.0)
		More than 4 times	0 (0.0)
			8 (4.8)
Timing adherence	3: Do you remember having taken your anti-rejection medications more than 2 hrs before or after the recommended dosing time in the last 4 weeks?	Once	23 (14.0)
		2–3 times	14 (8.3)
		4–5 times	12 (7.1)
		Every 2–3 days	8 (4.8)
		Almost every day	2 (1.2)
			59 (35.1)
Dose alteration	4: Have you altered the prescribed amount (for example, taken more or fewer pills or changed your dose) of your anti-rejection medications during the last 4 weeks, without your doctor telling you to do so?	Yes	7 (4.2)
			7 (4.2)
Overall nonadherence			69 (41.1)

Notes: ^aFor patients who answered “yes” to 1 Bold values of the table were the sums of patients have positive answers to the dimensions.

Abbreviation: BAASIS, basel assessment of adherence to immunosuppressive medication scale.

Table 2 Differences Between Adherent and Nonadherent Patients About Socio-Demographic, Transplant-Related, Healthcare System Access and Post-Transplant Treatment-Related Factors

Characteristics	Total Sample (n=168)	Adherent (n=99)	Nonadherent (n=69)	P
Socio-demographic factors
Age, years (IQR)	51.5 (41.0–58.0)	51.0 (41.0–58.0)	52.0 (41.0–59.0)	0.768
Male sex (%)	141 (83.9)	81 (81.8)	60 (87.0)	0.372
Education level: less than high school (%)	74 (44.0)	37 (37.4)	37 (53.6)	0.037
Monthly income < 3000 CNY (%)	72 (42.9)	31 (31.3)	41 (59.4)	<0.001
Marital status: single/divorced/widowed (%)	27 (16.1)	15 (15.2)	12 (17.4)	0.697
Living alone (%)	19 (11.3)	8 (8.1)	11 (15.9)	0.139
Transplant-related factors
Years after transplantation (SD)	2.9 (2.0)	2.9 (2.1)	3.1 (1.7)	0.498
Age at the time of transplantation (IQR)	46.1 (12.5)	45.9 (12.7)	46.4 (12.3)	0.804
Healthcare system access factors
Living in rural (lack of transportation) (%)	45 (26.8)	20 (20.2)	25 (36.2)	0.021
Type of insurance (%)				0.165
Medical insurance for urban and rural residents	94 (56.0)	51 (51.5)	43 (62.3)
Employee basic medical insurance	74 (44.0)	48 (48.5)	26 (37.7)
Post-transplant treatment-related factors
Immunosuppressive medication (%)
Prednisone	154 (91.7)	89 (89.9)	65 (94.2)	0.402
Sirolimus	8 (4.8)	4 (4.0)	4 (5.8)	0.718
Daily dose of tacrolimus (IQR)	2.8 (2.0–4.0)	3.0 (2.0–4.0)	2.8 (2.0–4.0)	0.710
Comorbidities
Diabetes	61 (36.3)	36 (36.4)	25 (36.2)	0.986
Hypertension	131 (78.0)	76 (76.8)	55 (79.7)	0.651
Hyperlipemia	100 (59.5)	61 (61.6)	39 (56.5)	0.508
Hyperuricemia	60 (35.7)	34 (34.3)	26 (37.7)	0.657
Number of prescribed concomitant drugs (IQR)	5.5 (4.0–7.0)	5.0 (3.0–7.0)	6.0 (5.0–8.0)	0.004

Note: The bold values indicate these variables that were statistically significant (p<0.05).

Abbreviations: CNY, Chinese Yuan; IQR, interquartile range; SD, standard deviation.

Table 3 Differences Between Adherent and Nonadherent Patients About Patient-Related Psychosocial Factors

Characteristic	Total Sample (n=168)	Adherent (n=99)	Nonadherent (n=69)	P
Necessity (IQR)	20.0 (18.3–23.0)	20.0 (19.0–23.0)	20.0 (18.0–23.0)	0.439
Concerns (SD)	18.1 (4.5)	17.3 (4.2)	19.3 (4.6)	0.003
Anxiety score (IQR)	11.0 (9.0–14.0)	12.0 (10.0–14.0)	10.0 (9.0–13.0)	0.041
Depression score (IQR)	9.0 (8.0–11.0)	10.0 (8.0–12.0)	9.0 (7.5–11.0)	0.290
Social support (IQR)	24.0 (23.0–29.0)	24.0 (23.0–29.0)	24.0 (23.0–28.5)	0.981
PCS score (SD)	46.6 (7.0)	48.0 (6.9)	44.6 (6.7)	0.002
MCS score (IQR)	47.8 (42.2–50.9)	49.1 (44.6–51.2)	44.4 (40.5–48.9)	0.001

Note: The bold values indicate these variables that were statistically significant (p<0.05).

Abbreviations: IQR, interquartile range; SD, standard deviation; PCS, Physical Component Summary; MCS, Mental Component Summary.

Table 4 Logistic Regression Model for the Risk Factors of NonAdherence

	Regression Coefficient B	Wald	Odds Ratio	95% Confidence Interval	P (Single Risk Factors)	P (Whole Model)
Monthly income< 3000 CNY	1.14	10.78	3.11	1.58–6.12	0.001	< 0.001
Number of prescribed concomitant drugs	0.20	8.83	1.23	1.12–1.50	0.003
Concerns	0.09	4.67	1.09	1.01–1.18	0.031

Abbreviation: CNY, Chinese Yuan.