Screening Beyond Dependence: At-Risk Drinking and Psychosocial Correlates in the Heart Transplant Population

<b>Background/Objectives</b>: Psychosocial factors (e.g., adherence, substance use) contribute to increased morbidity and mortality after heart transplantation. We investigated alcohol consumption patterns and their associations with psychosocial factors in adults, who underwent heart transplantation surgery (HTX recipients). <b>Methods</b>: Our cross-sectional study was conducted at the Semmelweis University Heart and Vascular Centre between 2023 and 2025. In total, 201 HTX recipients (75.6% male, mean age: 56.33 ± 11.46 years) completed the Alcohol Use Disorders Identification Test (AUDIT), Brief Health Literacy Screening Tool (BRIEF), Medication Adherence Report Scale (MARS-5) modified to immunosuppressive medication, and 9-item Beck Depression Inventory (BDI-9). Statistical analysis included Pearson's correlation tests and Multivariate Regression Analyses. <b>Results</b>: The AUDIT had a higher proportion of non-evaluable responses than other questionnaires (AUDIT 19.9% vs. 5.5-9%), with 41.0% of the participants abstinent, 54.7% low-risk, 4.3% medium-risk, and 6.5% at-risk drinkers. AUDIT correlated negatively with MARS-5 (r = -0.326; <i>p</i> = 0.000) and positively with BDI-9 (r = 0.208; <i>p</i> = 0.010). At-risk drinking was associated with a lower MARS-5 (r = -0.231; <i>p</i> = 0.002). Multivariate regression models significantly predicted the AUDIT (F = 5.106; <i>p</i> < 0.001, R² = 0.216) and AUDIT-C (F = 3.804; <i>p</i> = 0.002; R² = 0.146), with sex and adherence as independent predictors. <b>Conclusions</b>: The high proportion of non-evaluable AUDIT responses suggests limitations in multi-questionnaire use but does not diminish its clinical relevance. The presence of 6.5% at-risk and 4.3% medium-risk drinkers highlights the relevance of consumption pattern screening, beyond diagnosing alcohol use disorder. Associations between AUDIT, MARS-5, and BDI-9 emphasize the necessity for multidisciplinary care.