Background: Anxiety and depression are common after heart transplantation. This study aimed to pilot test the\nfeasibility of a clinical model of psychological care for heart transplant recipients. The model of care involved\nnurse-led screening for anxiety and depression followed by referral for a course of telephone-delivered cognitive\nbehaviour therapy as well as co-ordination of communication with on-going specialist and primary care services.\nMethods: A pilot randomised controlled trial was conducted. Heart transplant recipients who self-reported at least\nmild anxiety or depressive symptoms were randomised (defined as a score higher than 5 on the Patient Health\nQuestionnaire-9 or the Generalized Anxiety Disorder-7 [GAD-7], or a score higher than 20 on the Kessler\nPsychological Distress Scale [K10]). The primary outcome was assessment of feasibility of conducting a larger trial,\nwhich included identification of recruitment and attrition rates as well as the acceptability of the intervention.\nFollow-up was conducted at 9 weeks and 6 months.\nResults: One hundred twenty-two of the 126 (97 %) heart transplant recipients assessed on their attendance at\nthe outpatient clinic met the study eligibility criteria. Of these patients, 88 (72 %) agreed to participate. A\nmoderate proportion of participants (n = 20; 23 %) reported at least mild symptoms of anxiety or depression.\nFive participants were excluded because they were currently receiving psychological counselling, two withdrew\nbefore randomisation and the remaining 13 were randomised (seven to intervention and six to usual care). The\nmajority of the randomised participants were male (n = 9; 69 %) and aged over 60 (range 35ââ?¬â??73). Median length\nof time post-transplant was 9.5 years (ranging from 1 to 19 years). On enrolment, 3 randomised participants\nwere taking anti-depressants. One intervention group participant withdrew and a further 3 (50 %) declined the\ntelephone-delivered CBT sessions; all because of restrictions associated with physical illnesses. Attrition was 30 %\nat the 6 month follow-up time-point.\nConclusions: Due to the poor acceptability of telephone-delivered cognitive behavioural therapy observed in our\nsample, changes to intervention components are indicated and further pilot testing is required.
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