Pharmaceutical care in immunosuppressive therapy for heart transplant patients in ceará
Objective: To assess the impact of adherence to immunosuppressive therapy in association with therapeutical care for heart transplant patients in Ceará. Method: Randomized clinical study, performed in a public hospital in the state of Ceará, which verified the adherence to treatment through self-report, BAASIS scale (Basel Assessment of Adherence Scale for Immunosuppressives) and measurement of serum levels of immunosuppressants. In the statistical analysis, the Kolmogorov-Smirnov normality test for numerical variable, the Qui-square test for categorical variable and the Mantel-Haenszel test to verify the association of variables in stratified analysis were applied. Significant value of p < 0.05 was considered. Initially, 202 patients were recruited according to eligible criteria, which 101 patients were randomized. 91 patients concluded the study, 45 in Control Group (CG) and 46 in Intervention Group (IG). Results and discussion: The mean ageof heart transplant of CG was 53 (standard deviation, SD±12), and in IG, the mean was 54 years (SD±10). Most participants were male in both groups. The etiology that more led patients for heart transplantation in both groups (CG and IG) was ischemic cardiomyopathy (CM). Rejection episodes were found in CG (n=15, 33.3%) and IG (n =12, 26.1%) participants. The measure of adherence to immunosuppressantsusing the BAASIS scale presented that, at the beginning of the search, 23 patients in the CG (51.1%) and 24 in the IG (52.2%) did not adhere to the treatment. At the end of the search, greater adherence to the immunosuppressive treatment was observed in patients in the IG (89.1%), against 68.1% in patients in the CG, p=0.003. In the assessment of adherence to immunosuppressants through blood levels, the valued obtained at the beginning indicated that the groups showed differences; at the end of the search, the groups remained distinct. Conclusion: Patients who received pharmaceutical accompaniment presented greater adherence to immunosuppressants when compared to the control group (p=0.003), when measured by self-report. Therefore, the pharmaceutical cares oriented by intervention and strategies were capable to optimize the adherence to immunosuppressive therapy in heart transplant patients.