Quality of life in heart transplant candidates

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1 ORIGINAL ARTICLE Rev Bras Cir Cardiovasc 009; (1): Quality of life i heart trasplat cadidates Qualidade de vida dos cadidatos a trasplate de coração Reata Almeida Barros HELITO 1, João Nelso Rodrigues BRANCO, Maria D INNOCENZO, Regimar Carla MACHADO, Eio BUFFOLO 5 RBCCV Abstract Objective: To assess the quality of life of patiets with refractory heart failure disease as cadidates for heart trasplat. Methods: A trasversal, descriptive ad prospective study with adult patiets, with mea age of 5 years uder pretrasplatatio outpatiet follow-up at educatioal ad public hospital i São Paulo tow. The quality of life was assessed by referece to The Medical Outcomes Study 6- item Short-Form Health Survey (SF-6) geeric questioaire i order to assess the aspects i relatio to the fuctio, dysfuctio, physical ad emotioal ueasiess. Results: Accordig to this group, 1 (77.) of these patiets were male ad four () female; 1 (77.) of them were classified as fuctioal class IV ad four () as fuctioal class III (New York Heart Associatio); 17 (9.) of them were at stage D ad oe (5.6) at stage C (America Heart Associatio/America College of Cardiology). The mea results obtaied from the assessmet of SF-6 scales were: fuctioal capacity, pai 9, health geeral coditio 9, vitality 9, social aspects 5, emotioal aspects ad metal health 5. Coclusio: The quality of life of patiets presetig termial heart failure is cosidered to be very bad; it is likely to be worse tha i may other more commo morbid etities. Both metal ad social aspects are least affected, o the other had the vitality ad fuctioal capacity are the most affected. Descriptors: Quality of life. Sickess impact profile. Cardiac failure. Heart trasplatatio. Resumo Objetivo: Aferir a qualidade de vida de pacietes com isuficiêcia cardíaca refratária, iscritos como cadidatos a trasplate de coração. Métodos: Estudo prospectivo, descritivo, trasversal de pacietes, com média de idade de 5 aos, em acompahameto ambulatorial pré-trasplate, de um hospital público e viculado ao esio do Muicípio de São 1. Master s Degree Studet i Scieces Cardiovascular Surgery Departmet (Nursig Auditor).. Full Professor i Cardiovascular Surgery of UNIFESP/EPM. (Adjuct Professor, Full Professor of the Disciplie of Cardiovascular Surgery of the Surgery Departmet of UNIFESP/EPM.. PhD i Nursig by UNIFESP/EPM. (Adjuct Professor, PhD of the Disciplie of Health Public ad Admiistratio applied to Nursig of the Nursig Departmet of UNIFESP/EPM.. Master s Degree i Scieces Cardiovascular Surgery Departmet of UNIFESP/EPM. (Professor of the Nursig Course of Vale do Paraíba Uiversity UNIVAP, São José dos Campos SP). 5. Full Professor. Titular Professor of the Disciplie of Cardiovascular Surgery of the Surgery Departmet of UNIFESP/EPM. This study was carried out at Post-Graduatio Program i Cardiovascular Surgery of UNIFESP/EPM. Study carried out at Cardiac Surgery Outpatiet of São Paulo Hospital. Correspodece address: Reata Almeida Barros Helito R. José Atoio Coelho, º 661, apto. 6 - CEP Vila Mariaa São Paulo - SP Foe: (11) helitoreata@gmail.com Article received o Jue 9 th, 00 Article accepted o December 15 th, 00 50

2 HELITO, RAB ET AL - Quality of life i heart trasplat cadidates Rev Bras Cir Cardiovasc 009; (1): Paulo. A qualidade de vida foi avaliada por meio do questioário geérico The Medical Outcomes Study 6-item Short-Form Health Survey (SF-6), com a fialidade de avaliar aspectos relativos a fução, disfução, descoforto físico e emocioal. Resultados: Dessa amostra, 1 (77,) pacietes eram do sexo masculio e quatro (,), do sexo femiio; 1 (77,) dos pacietes foram classificados segudo tipo fucioal IV e quatro (,) em tipo fucioal III (New York Heart Associatio); 17 (9,) ecotravam-se em estágio D e um (5,6) em estágio C (America Heart Associatio/ America College of Cardiology). As médias obtidas a avaliação das escalas do SF-6 foram: capacidade fucioal, dor 9, estado geral de saúde 9, vitalidade 9, aspectos sociais 5, aspectos emocioais e saúde metal 5. Coclusão: A qualidade de vida dos pacietes com isuficiêcia cardíaca termial é cosiderada muito ruim; provavelmete pior que em muitas outras etidades mórbidas mais comus. Os aspectos, social e metal são os meos afetados, sedo os mais comprometidos, a vitalidade e a capacidade fucioal. Descritores: Qualidade de vida. Perfil de impacto da doeça. Isuficiêcia cardíaca. Trasplate de coração. INTRODUCTION Cardiac isufficiecy (C.I.) is ackowledged worldwide as a public health problem due to the icreasig umber of cases arisig every year. I the last decade, CI became oe of the mai problems i public health, causig a source of cocer to defie health policies i Brazil [1]. CI ca be defied as a cliic sydrome i which a structural or fuctioal heart disorder causes decreasig i capacity of the vetricle to eject ad/or fill with blood durig physiological fillig pressure []. Cardiac affectios are umber oe as cause of death amog the populatio ad CI has become commo []. CI prevalece is growig, resultig from the icrease of Brazilias life expectatio ad greater efficiecy of ew medicie for the treatmet, thus prologig life []. I the 1990s, there was a evolutio of cliical ad surgical advacemets at treatig patiets with CI i more advaced stages, modifyig i this way, the morbidity ad mortality related to the illess. Durig this period, ew classes of medicie came upo of which were assessed after iumerable multicetral studies ad that cofirmed their beefits, permittig ot oly a loger life after the illess, but also a improvemet of the patiets quality of life (Q.L.) [5]; evertheless, recogitio, fast treatmet ad, whe possible, prevetio of the factors that cause or worse CI are crucial whe hadlig the patiet. The icrease of survival with the treatmet has bee show for each stage of the illess, from dysfuctio of the asymptomatic left vetricle to severe symptomatic CI [6], Implemetatio of the therapeutic arseal seeks ot oly to icrease life after the illess, but also to improve the patiet s QL The term QL started to be used i the Uited States after World War II itedig to describe the effect geerated by acquirig techology i people s lives. Years later, QL started to be cosidered as a parameter to be valued at improvig advacemets i the health ad educatio areas [7]. It is ot easy to defie QL. It is a itimate feelig of comfort, well-beig or happiess at performig oe s physical, itellectual ad psychic fuctio, withi oe s family s reality, at work, values of a commuity to which oe belogs, ad that oly the oeself ca assess []. Despite therapeutic implemetatio to treat CI i the last few years, i the more advaced cases of the illess - called CI i termial phase - the results are ot ecouragig, reachig high mortality rates i few moths. CI i termial phase is uderstood as a patiet with expressive limitatios of his activities, whereas the classic treatmets ad the itervetioal procedures performed do ot allow to prolog these patiets lives [1]. I this phase, the oly therapeutic optio to revert the status ad improve QL is heart trasplat (HT). Classic sigs of refractory cardiac isufficiecy are described by several authors [,6,9]. HT, before cosidered a fatastic speculatio for the future, is today uquestioably accepted o loger as a experimetal procedure, but as a effective method to treat hopeless patiets, without the pleasure or satisfactio of a healthy ad worthy existece or, eve worse, ruig the risk of losig their greatest asset: life []. Despite the restructurig of the orga ad tissue trasplat system i Brazil, the icreasig umber of trasplat ceters ad performed trasplats, balace betwee the umber of doatios ad demad of receivers has ot happeed. This situatio makes the patiet stay more time i the trasplat waitig list, worseig the cliic status, decadece of his physical ad psychological 51

3 HELITO, RAB ET AL - Quality of life i heart trasplat cadidates Rev Bras Cir Cardiovasc 009; (1): coditio ad QL; icreasig surgical risk ad possibly leadig to death. I this way, the aim of this study was: to check the quality of life of patiets with refractory cardiac isufficiecy, erolled as heart trasplat cadidates, by meas of a stadardized ad complemeted questioaire (SF-6). Possibly, i the future, it ca be a istrumet to compare with other populatioal groups with cardiopathies or other illesses. METHODS It is a prospective, descriptive, exploratory ad trasversal study, with a quatitative approach. After approval from the Research Ethics Committee of the Federal Uiversity of São Paulo Paulista School of Medicie (UNIFESP EPM), respectig Resolutio Nº 196/96 of the Miistry of Health, data collectio bega, which took place at the Cardiovascular Surgery Outpatiet Cliics of a public hospital related to teachig i the City of São Paulo, from March 11 to May 0, 005. The sample cosisted of patiet cadidates to receive a heart trasplat. Iclusio criteria were: all patiets that were erolled i the heart trasplat waitig list durig the period of the survey, years of age or over, regardless geder, besides acceptig to participate i the study, sigig a writte iformed coset. Exclusio criterio was to ot accept to participate i the study. Data were collected by meas of idividual iterviews, ad a istrumet already validated ad traslated ito Portuguese was chose to be used, a geeric questioaire to assess quality of life: The Medical Outcomes Study 6 item Short Form Health Survey, traslated by Cicoelli, i 1997 [11], commoly called SF-6, whose purpose is to reflect the impact of a illess o lives of patiets i a large variety of populatios. I the pre-test phase, i which patiets filled out the istrumet, it was observed they were cofused facig the variables of each questio ad eded up aswerig radomly; due to this fact, the iterview method was chose. Several statistical methods were used to tabulate ad aalyze the questioaire applied to collect data. For those referrig to social-demographic variables, percetages ad simple frequecies were used. The sample of this study cosisted of patiets i the heart trasplat waitig list of the Cardiovascular Surgical Outpatiet Cliics of the referred hospital. Socialdemographic characterizatio of the iterviewed patiets is preseted i Tables 1 ad. Patiets mea age was 5, varyig from 5 to 67. Most were me (1 patiets; 77. of the total), whereas () married, four () i cocubiage ad three () sigle. Regardig educatio, 1 (7.) graduated from middle school, followed by two () graduated from high school ad three () graduated from college. Table 1. Age (years) Table. Age distributio of patiets i the heart trasplat waitig list. Miimum 5 GENDER Female Male TOTAL Educatio Middle School High School Uiversity TOTAL Maital Status Married Divorced Cocubiage Sigle TOTAL Middle 5 Maximum 67 Average 5.5 Stadard Deviatio 9.1 Patiet distributio accordig to social-demographic variables # Regardig the istrumet chose to assess the quality of life of patiets i the heart trasplat waitig list, the data iteded to aalyze the Quality of Life accordig to aswers give by patiets through The Medical Outcomes Study 6-item Short-Form Health Survey (SF-6) questioaire ad preseted i Tables,, 5 ad 6. I Table we observe the curret health classificatio that seve (.9) report as good, eight (.) patiets classify their health as bad ad three () as very bad. Comparig their curret health coditio to that oe year ago, three () report it beig much better ow, four () refer to it as a little better ow, three () as a little worse ow ad three () iform that their health preseted o chages i oe year. O the other had, five (7.) patiets classified their health as much worse ow tha a year ago. 5

4 HELITO, RAB ET AL - Quality of life i heart trasplat cadidates Rev Bras Cir Cardiovasc 009; (1): Table. Relative ad simple frequecy distributio of the SF-6 questios related to the patiet s curret ad oe year before health status. I geeral, you would say your health is good bad very bad How would you classify your geeral health, compared to oe year ago? much better ow a little better ow almost the same a little worse ow much worse ow N 7 N I Table, we observe a evaluatio of physical performace capacity: Fourtee (77.) patiets iformed beig difficult to perform vigorous activities, three () beig a little difficult ad oe (5.6) ot beig difficult. Whe describig activities that demad physical vigor pickig up ad carryig groceries, climbig several staircases, climbig oe staircase, bedig dow, keelig, walkig more tha 1 km, walkig several blocks, walkig oe block, takig a shower or gettig dressed patiets stated at least oe or more activities i which it was difficult to perform. I Table 5, we ca observe that the occurrece of problems at work resultig from some emotioal problem, yes was aswered by (), had decreased the amout of time dedicated to work was aswered by 11 (61.1) patiets who said they had doe less tasks tha they would like, ad () said they had ot worked or doe ay kid of activity with so much care as they geerally did. I Table 6, we ca observe that the questio about the illess iterferig i ormal social activities, regardig family, eighbors, frieds or i group, six (.) patiets aswered that there was o iterferece () slightly, oe (5.6) reported moderately ad four () said there was much iterferece or sometimes extreme. Table. Relative ad simple frequecy distributio for questio related to difficulty i performig activities. Due to your health, do you fid it difficult to perform these activities? I this case, how much? Difficulty at vigorous activities Difficulty at moderate activities Difficulty at liftig or carryig groceries Difficulty at climbig several staircases Difficulty at climbig oe staircase Difficulty at activities such as bedig dow or keelig Difficulty at walkig more tha 1 km Difficulty at walkig several blocks Difficulty at walkig oe block Difficulty at takig a shower or gettig dressed Yes. Very difficult Yes. A little difficult No. Not ay difficulty

5 HELITO, RAB ET AL - Quality of life i heart trasplat cadidates Rev Bras Cir Cardiovasc 009; (1): Table 5. Relative ad simple frequecy distributio for SF-6 questio. I the last weeks, have you had ay of the followig problems with your work or other daily activity as cosequece of ay emotioal problem (like feeligdepressed or axious)? Have you decreased the amout of time you dedicated to your work or other activities? Have you performed less tasks tha you would like to? Have you ot worked or ot performed ay of the activities with as much care as you geerally do? Yes No Table 6. Relative ad simple frequecy distributio SF-6 questio related to the iterferece i ormal social activities regardig family, eighbors, frieds or i group. Iterferece i ormal social activities, regardig family, eighbors, frieds or i group o way slightly moderately a lot extremely DISCUSSION CI is a commo sydrome ad a progressive coditio that ivariably leads to chroicity [5]. By implemetig the therapeutic arseal, may patiets ca be beefited; however, a small part of the populatio affected by this illess will ievitably be icluded i the lists of trasplats. Social assessmets are elaborated i cardiac trasplat programs itedig to verify the occurrece of the most adverse factors that might stop the iclusio of patiets i these programs. By performig iterviews, it is iteded to idetify the patiet s social status by classifyig some categories extracted from daily life, structured i: acceptability, family dyamics, access ad social-ecoomic situatio [1]. I our coutry, accordig to data from the Brazilia Orga Trasplat Associatio (A.B.T.O.), durig 006, there were patiets waitig for a heart ad 7 registered teams [1]; few teams had more tha 0 patiets o their list, whereas most had three or four registered patiets. I this N way, it is uderstadable why this study cosisted of oly patiets, which was the umber of those erolled at the istitutio whe the survey was performed. I the scietific commuity, several researchers evaluate patiets life after the cardiac illess; however, it is observed that there are few studies discussig QL, whereas it is a importat factor for maitaiig huma digity. To some people, prologig life is ot a coditio as importat as the quality of the life they will have. As oe of our patiets said: Doctor, I do t eed to live much, but I wat to live well the little life I still have. Evaluatig QL becomes a challege ad preoccupatio of all those who worry about the well-beig of people [1]. I the last years, oe of the greatest developmets i the health field, has bee recogizig the importace of the patiet s poit of view regardig his illess, as well as moitorig the quality of the therapeutic meas used [15]. Regardig age, patiets i this study varied betwee 5 ad 67, with a mea of 5. These results are compatible with DATASUS data that iforms that the largest umber of hospital stay due to CI occurs with patiets of age 60 or over, followed by patiets i the 0 59 age rage [16]. The studied populatio cosisted of 1 (77.) me ad four () wome, but it seems that geder, as a progostic factor, is ot clear i the literature [17]. Hece the fact that the patiets filled out the istrumets radomly durig the pre-test phase by beig cofused with the variables of each questio, this fact is probably due to their little educatio, whereas 1 (7.) fiished middle school, two () fiished high school ad three () had a college degree. Educatio is importat to follow ad cotiue the treatmet; kowig how to read, write ad iterpret are decisive factors to uderstad istructios of the proposed treatmet, exams to be performed ad care to be take. Besides this, it is fudametal that the patiet is able to uderstad ad 5

6 HELITO, RAB ET AL - Quality of life i heart trasplat cadidates Rev Bras Cir Cardiovasc 009; (1): assimilate istructios, which demads a miimum thikig traiig, which is acquired with educatio []. Regardig the studied populatio s marital status, most were married ad some i cocubiage. It is importat to cosider family as a essetial part of huma care, because it is the family that will frequetly share with the patiet his fear, sadess, axiety, sufferig ad happiess, geeratig more itegratio amog them [19]. Several istrumets have bee proposed ad used itedig to assess the QL of patiets with the most diverse illesses. Choosig a certai istrumet depeds o the aim of its proposal, its practicality ad the populatio to be studied. The optio to use SF-6 happeed after verifyig that most istrumets that assess QL are developed i Eglish, directed to populatios that speaks that laguage [] ad that curretly it is agreed that such meas must ot oly be traslated carefully, but also have their psychometric measuremets tested i a specific cultural cotext [0]. It is a istrumet with large acceptace, compact, easy to iterpret, validated ad applied i our coutry ad i other laguages, permittig compariso with other results. Ad there are authors who apply treatmets that attempt to improve QL, actig as a bridge to defiitive treatmet [1]. Cosiderig that refractory cardiac isufficiecy is a chroic ad progressive coditio, the first result aalyzed from the SF-6 questioaire does ot reveal totally uexpected. The populatio was requested to classify their curret health accordig to a score defied as: good, bad ad very bad. I the sample, eight (.) patiets classified their health as bad ad three () as very bad, o the other had, it was observed that seve (.9) surprisigly classified their health as good i this phase of the illess. These results (bad ad very bad) are comparable to those foud i the literature [17,,]; cardiovascular illesses are those that most edager patiets cliic coditio, as well as their perceptio of health ad QL. However, we did ot fid data that would justify the uexpected aswer of seve (.9) patiets who cosidered, despite all, their health as good. Comparig their curret health status to that oe year before, 5 (7.) patiets classified their health as much worse ow, three () as a little worse ow, three () iformed that their health has ot preseted chages i oe year, four () stated a little better ow ad three () much better ow tha oe year before. I our opiio, it is highly criticizable the fact that the questioaire does ot cosider the time of the illess; perhaps this fact could ifluece the aalysis of the aswers to the questioaire. For example, a patiet who has recetly etered the trasplat list could possibly ot have the illess oe year before. The survey did ot assess the time the patiet has bee erolled as a cadidate for HT, followed correctly medicatio ad the momet s cliical coditio. The choice for HT is the last therapeutic alterative for the patiet with refractory cardiac isufficiecy, which imposes a much jeopardized cliical coditio, with progressive worseig of his health status [1,,17,]. Physical weakess is a evidet coditio i this phase of refractory cardiac isufficiecy, whereas the lack of eergy is oe of the patiets mai complaits. [17] I our study of assessig physical performace capacity, 1 (77.) patiets iformed beig difficult to perform vigorous activities, three () beig a little difficult ad oe (5.6) ot beig difficult. Whe describig activities that demad physical vigor pickig up ad carryig groceries, climbig several staircases, climbig oe staircase, bedig dow, keelig, walkig more tha 1 km, walkig several blocks, walkig oe block, takig a shower or gettig dressed patiets stated at least oe or more activities i which it was difficult to perform. I this way, physical compromisig is commo i other cardiovascular illesses, however, by compesatig the cliical status (medicatio optimizatio, cliical cotrols, physiotherapy, ad psychological follow up), the patiet feels disposed ad active agai, but i the iitial assessmet of the patiet with refractory cardiac isufficiecy, this coditio is ot preset. I the fuctioal capacity assessmet, which aalyzes the presece as well as the extesio of limitatios related to physical capacity, it was observed i the fial score that the patiets had a mea of (rememberig that less tha 50 shows a compromised stadard). Regardig the occurrece of problems at work resultig from some emotioal problem, yes was aswered by 11 (61.1) patiets who said they had doe less tasks tha they would like, () said they had ot worked or doe ay kid of activity with so much care as they geerally did, (55,6) had decreased the amout of time dedicated to work. Whe we observe the score obtaied both regardig to the physical (1) or the emotioal aspect (), we otice that these results are compromised, what cofirms the great loss of physical coditio to develop heavy activities ad the decrease of time that the patiet dedicates to work or other activity. The work locates ma i society ad his eviromet, which reiforces Assis statemets that limitatios imposed by the illess coduct the idividual to labor icapacity, which makes him cofrot life s ow fragility ad vulerability []. The score whe assessig social aspects was 50. Whe asked if the illess iterfered i ormal social activities, regardig family, eighbors, frieds or i group, () patiets aswered that there was o iterferece or slightly, or moderately, eight (.) said there was much iterferece ad sometimes 55

7 HELITO, RAB ET AL - Quality of life i heart trasplat cadidates Rev Bras Cir Cardiovasc 009; (1): extreme. Whe asked to assess how much time their health or emotioal problems iterfered i their social activities, six (.) patiets said all the time, two () patiets aswered most of the time, four () patiets aswered a small part of the time ad six (.) said o part of the time. Diagosis of a chroic illess is always a factor of rupture, of losses ad of itese psychological ad social disorgaizatio. Emotioal reactios that accompay facig the process of becomig ill result from the combiatio of several factors (idividual history, persoality dyamics, ad autoomy of the idividual i the affective, fiacial ad social areas). Besides this, such reactios result from family dyamics. Psychic ad social disorgaizatio, imply o the structural disturbace of the patiet s idetity, as well as his familiar idetity [5]. Assessig the metal health aspect, the score was 56. This result makes believe that there is o sigificat chage regardig metal health, which is good i this period waitig for the orga, ad it will help postoperative recovery. Whe the illess pheomeo iterrupts the idividual s life, it geerates psychic cosequeces. Beig ill ca mea fragility ad depedece. Every illess makes patiets vulerable to some categories of psychological stress; those more frequet ca be sythesized i: perceptio of self-itegrity ad the relatio with self-esteem, separatio axiety ad fears regardig loss ad pai [5]. Despite havig created differet protocols to aalyze QL, this subject cotiues to be a difficult assessmet etity, although we have a subjective impressio, it is difficult to measure QL ad there is o uiformity regardig the assessmet istrumets i the several health istitutios. CONCLUSIONS SF 6 is a applicable istrumet, geeratig data to be compared with other populatioal groups, cardiopathy patiets or patiets with other illesses. QL of patiets with refractory cardiac isufficiecy is cosidered very bad. These patiets vitality ad fuctioal capacity are the most committed dimesios i this phase of the illess. These patiets social ad metal aspects are the less affected. REFERENCES 1. Rossi Neto JM. A dimesão do problema da isuficiêcia cardíaca do Brasil e do mudo. Rev Soc Cardiol Estado de São Paulo. 00;1(1):1-.. Douglas CR. Fisiologia do coração. I: Douglas CR, editor. Tratado de fisiologia aplicada às ciêcias da saúde. 1ª ed. São Paulo:Robe;199.p Pereira WL. Qualidade de vida após o trasplate cardíaco: aálise de pacietes operados a Uiversidade Federal de São Paulo [Tese de doutorado]. São Paulo:Uiversidade Federal de São Paulo;000.. Araújo DV, Tavares LR, Veríssimo R, Ferraz MB, Mesquita ET. Custo da isuficiêcia cardíaca o Sistema Úico de Saúde. Arq Bras Cardiol. 005;(5): Barroso E. Orgaização do trasplate cardíaco o Brasil e o Estado do Rio de Jaeiro. Rev SOCERJ. 00;15(): Timerma A, Pereira MP. Tratameto atual da isuficiêcia cardíaca cogestiva. Rev Soc Cardiol Estado de São Paulo. 000;(1): Ferraz MB. Qualidade de vida: coceito e um breve histórico. Jovem Médico. 199;:19-. I: Pereira WL. Qualidade de vida após o trasplate cardíaco: aálise de pacietes operados a Uiversidade Federal de São Paulo [Tese de doutorado]. São Paulo:Uiversidade Federal de São Paulo;000.. Nobre MRC. Qualidade de vida. Arq Bras Cardiol. 1995;6: Stolf NAG, Sadala MLA. Os sigificados de ter o coração trasplatado: a experiêcia dos pacietes. Rev Bras Cir Cardiovasc. 006;1():1-.. Braco JNR. Trasplate cardíaco: a experiêcia da Uiversidade Federal de São Paulo [Tese de Livre-Docêcia]. São Paulo:Uiversidade Federal de São Paulo;1997. I: Machado RC. Idetificação e caracterização de cuidadores de cadidatos a trasplate do coração: aálise de amostra de pacietes do ambulatório da UNIFESP [Dissertação de Mestrado]. São Paulo:Uiversidade Federal de São Paulo; Cicoelli RM, Ferraz MB, Satos W, Meião I, Quaresma MR. Tradução para a lígua portuguesa e validação do questioário geérico de avaliação de qualidade de vida SF-6 (Brasil S.F.- 6). Rev Bras Reumatol. 1999;9(): Braco JNR, Costa ISEA, Lobo Filho G, Moraes CR. I Diretrizes da Sociedade Brasileira de Cardiologia para trasplate cardíaco: IX. Orgaizaçäo do trasplate cardíaco o Brasil. Arq Bras Cardiol. 1999;7(Suppl 5): Associação Brasileira de Trasplate de Órgãos (A.B.T.O.). Dispoível em: < Acesso em: 6 ov Kadri T, Marielli I, Frake RA, Rivetti LA. Terapia e evolução do cadidato a receptor do trasplate cardíaco. Rev Soc Cardiol Estado de São Paulo. 1995;5(6):

8 HELITO, RAB ET AL - Quality of life i heart trasplat cadidates Rev Bras Cir Cardiovasc 009; (1): Bayley KB, Lodo MR, Grukemeier GL, Lasky DJ. Measurig the success of treatmet i patiet terms. Med Care. 1995;( Suppl):AS DATASUS. Morbidade hospitalar do SUS. Miistério da Saúde - Sistema de Iformações Hospitalares do SUS (SIH/SUS) 007. Ref. Type: Electroic Citatio. 17. Guimarães JI, Mesquita ET, Bocchi EA, Vilas-Boas F, Motera MW, Moreira MCV, et al. II Diretrizes da Sociedade Brasileira de Cardiologia para o Diagóstico e Tratameto da Isuficiêcia Cardíaca. Arq Bras Cardiol. 00;79(Supl. IV):1-0.. Rabelo ER, Aliti GB, Domigues FB, Ruschel KB, Bru AO. O que esiar aos pacietes com isuficiêcia cardíaca e por quê: o papel dos efermeiros em clíicas de isuficiêcia cardíaca. Rev Latioam Eferm. 007;15(1): Machado RC. Idetificação e caracterização de cuidadores de cadidatos a trasplate de coração: aálise de amostra de pacietes do ambulatório da UNIFESP [Dissertação de Mestrado]. São Paulo:Uiversidade Federal de São Paulo; Guillemi F, Bombardier C, Beato D. Cross-cultural adaptatio of health-realted quality of life measures: literature review ad proposed guidelies. J Cli Epidemiol. 199;6(1): Frota Filho JD, Lucchese FA, Blacher C, Halperi C, Jawetz J, Lúcio EA, et al. Três aos de vetriculectomia parcial esquerda: resultados globais e tardios em 1 pacietes. Rev Bras Cir Cardiovasc. 1999;1(): Stewart AL, Greefield S, Hays RD, Wells K, Rogers WH, Berry SD, et al. Fuctioal status ad well-beig of patiets with chroic coditios. Results from the Medical Outcomes Study. JAMA. 199;6(7): Martis LM, Fraca APD, Kimura M. Qualidade de vida de pessoas com doeça crôica. Rev Latioam Eferm. 1996;():5-.. Assis FN. Esperado um coração: doação de órgãos e trasplate o Brasil. 1ª ed. Pelotas:Uiversitária; Diiz DP, Levesteias I. Trasplate e repercussões psíquicas. I: Diiz DP, Schor N, editores. Qualidade de vida. Guias de medicia ambulatorial e hospitalar UNIFESP- Escola Paulista de Medicia. 1ª ed. São Paulo:Maole;006. p