The case was for a male patient at the age of 26 who was hospitalized by cardiac failure
for the first time. He was diagnosed as DCM with EF 21% and catecholamine dependency
continued for 2 months. CPX at the time of discharge indicated Peak VO2 9.3 ml/kg/min
and determined medical indication of heart transplant. However, he left from the hospital
without permission twice and could not follow the rules or the compliance. He was
discharged at the level of NYHAIII when it did not reach to a judgement for social
indication of heart transplant. He visited the hospital as an outpatient every 2 weeks
after the discharge and a self-care program was thoroughly conducted. The adherence
was gradually improved through a participation in self-treatment. Then, he was hospitalized
again after 2 months due to exacerbation of heart failure. However, unlike the first
hospitalization, he was referred to a transplant facility due to his request for heart
transplant. Both medical indication and social indication will be required for determining
heart transplant. For young patient with severe heart failure, it would be difficult
to gain adherence for heart transplant in a short period of time. The present case
demonstrated that compliance could be improved in a short period of time by actively
introducing self-care and participating in self-treatment.
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