Cardiovascular Management of Patients Undergoing Hematopoietic Stem Cell Transplantation: From Pretransplantation to Survivorship: A Scientific Statement From the American Heart Association

Hematopoietic stem cell transplantation can cure various disorders but poses cardiovascular risks, especially for elderly patients and those with cardiovascular diseases. Cardiovascular evaluations are crucial in pretransplantation assessments, but guidelines are lacking. This American Heart Association scientific statement summarizes the data on transplantation-related complications and provides guidance for the cardiovascular management throughout transplantation. Hematopoietic stem cell transplantation consists of 4 phases: pretransplantation workup, conditioning therapy and infusion, immediate posttransplantation period, and long-term survivorship. Complications can occur during each phase, with long-term survivors facing increased risks for late effects such as cardiovascular disease, secondary malignancies, and endocrinopathies. In adults, arrhythmias such as atrial fibrillation and flutter are the most frequent acute cardiovascular complication. Acute heart failure has an incidence ranging from 0.4% to 2.2%. In pediatric patients, left ventricular systolic dysfunction and pericardial effusion are the most common cardiovascular complications. Factors influencing the incidence and risk of complications include pretransplantation therapies, transplantation type (autologous versus allogeneic), conditioning regimen, comorbid conditions, and patient age. The pretransplantation cardiovascular evaluation consists of 4 steps: (1) initial risk stratification, (2) exclusion of high-risk cardiovascular disease, (3) assessment of cardiac reserve, and (4) optimization of cardiovascular reserve. Clinical risk scores could be useful tools for the risk stratification of adult patients. Long-term cardiovascular management of hematopoietic stem cell transplantation survivors includes optimizing risk factors, monitoring, and maintaining a low threshold for evaluating cardiovascular causes of symptoms. Future research should prioritize refining risk stratification and creating evidence-based guidelines and strategies to optimize outcomes in this growing patient population

Burnout, professional fulfillment, and post‐traumatic stress among pediatric solid organ transplant teams

BackgroundAdverse effects of clinician burnout have been studied across multiple specialties; however, there have been no studies examining rates of burnout among pediatric solid organ transplant teams. This study aimed to measure burnout, work exhaustion, professional fulfillment, and post‐traumatic stress symptoms among clinicians and administrators practicing in this high‐stress field.MethodsThis cross‐sectional study utilized a 50 item web‐based survey that included the Personal Fulfillment Index and the IES‐R. This survey was distributed across four pediatric solid organ transplant centers in North America. Basic demographics, clinician characteristics, and information regarding wellness and self‐care activities were collected. Descriptive and correlational analyses were performed.ResultsOne hundred and thirty five participants completed the survey, 76% were female and 78% were Caucasian. One‐third (34%) of participants endorsed burnout, while 43% reported professional fulfillment. Approximately 15% of respondents endorsed clinically significant levels of post‐traumatic stress symptoms related to patient deaths, with female clinicians more likely to endorse symptoms (p = .01). Nearly 80% of participants reported engaging in self‐care activities outside of work and only 10% of participants reported participation in hospital‐sponsored wellness programs.ConclusionsPediatric solid organ transplant team members exhibited moderate levels of burnout, professional fulfillment, and post‐traumatic stress. Female clinicians were the most likely to experience both work exhaustion and post‐traumatic stress symptoms. Transplant centers are encouraged to consider interventions and programming to improve clinician wellness.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167846/1/petr14020.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167846/2/petr14020_am.pd