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Zilla P, Human P, Pennel T. Mechanical valve replacement for patients with rheumatic heart disease: the reality of INR control in Africa and beyond. Front Cardiovasc Med 2024; 11:1347838. [PMID: 38404722 PMCID: PMC10884232 DOI: 10.3389/fcvm.2024.1347838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
The majority of patients requiring heart valve replacement in low- to middle-income countries (LMICs) need it for rheumatic heart disease (RHD). While the young age of such patients largely prescribes replacement with mechanical prostheses, reliable anticoagulation management is often unattainable under the prevailing socioeconomic circumstances. Cases of patients with clotted valves presenting for emergency surgery as a consequence of poor adherence to anticoagulation control are frequent. The operative mortality rates of reoperations for thrombosed mechanical valves are several times higher than those for tissue valves, and long-term results are also disappointing. Under-anticoagulation prevails in these regions that has clearly been linked to poor international normalised ratio (INR) monitoring. In industrialised countries, safe anticoagulation is defined as >60%-70% of the time in the therapeutic range (TTR). In LMICs, the TTR has been found to be in the range of twenty to forty percent. In this study, we analysed >20,000 INR test results of 552 consecutive patients receiving a mechanical valve for RHD. Only 27% of these test results were in the therapeutic range, with the vast majority (61%) being sub-therapeutic. Interestingly, the post-operative frequency of INR tests of one every 3-4 weeks in year 1 had dropped to less than 1 per year by year 7. LMICs need to use clinical judgement and assess the probability of insufficient INR monitoring prior to uncritically applying Western guidelines predominantly based on chronological age. The process of identification of high-risk subgroups in terms of non-adherence to anticoagulation control should take into account both the adherence history of >50% of patients with RHD who were in chronic atrial fibrillation prior to surgery as well as geographic and socioeconomic circumstances.
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Affiliation(s)
- Peter Zilla
- Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Ni H, Lin Y, Peng Y, Li S, Huang X, Chen L. Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model. Front Pharmacol 2022; 13:817406. [PMID: 35273498 PMCID: PMC8902640 DOI: 10.3389/fphar.2022.817406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms. Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy. Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes's PROCESS macro, based on the bootstrapping method. Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = -0.36, 95% CI: (-0.50, -0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β = 0.36, 95% CI: (0.23, 0.50)]. Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.
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Affiliation(s)
- Hong Ni
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yanjuan Lin
- Department of Nursing, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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Liu L, Huang W, Huang Z, Liu J, Zheng X, Tang J, Wu Y, Wang X, Liao Y, Cong L. Relationship Between Family Caregiver Burden and Medication Adherence in Patients with Mechanical Valve Replacement: A Structural Equation Model. Patient Prefer Adherence 2022; 16:3371-3382. [PMID: 36573227 PMCID: PMC9789713 DOI: 10.2147/ppa.s383269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/30/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Oral anticoagulant is a necessary long-term treatment after mechanical valve replacement (MVR), and medication adherence has a great impact on patients with MVR. Although family caregiver burden is negatively correlated with medication adherence, little is known about the underlying mechanism. PURPOSE To test whether family caregiver burden influences medication adherence through post-traumatic growth or medication literacy in patients with MVR. PATIENTS AND METHODS A total of 206 patients after MVR were included in this cross-sectional study from July 2021 to December 2021. Data regarding medication adherence, family caregiver burden, post-traumatic growth, and medication literacy were collected by questionnaires. Data were analyzed through SPSS, and pathway analysis was conducted by using AMOS, based on the bootstrapping method. RESULTS Post-traumatic growth was positively associated with medication adherence (r = 0.284, P < 0.05). Post-traumatic growth independently mediated the association of family caregiver burden on medication adherence [β = 0.32, 95% confidence intervals: (-0.016, -0.008)]. The mediated effect value for post-traumatic growth was 0.07, accounting for 24.14% of the total effect. The model's fit indices were adequate. CONCLUSION The mediating effect of post-traumatic growth between family caregiver burden and medication adherence existed in patients with MVR. Interventions considering post-traumatic growth may be useful to increase medication adherence and improve patient rehabilitation.
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Affiliation(s)
- Lijuan Liu
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Wenzhuo Huang
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Zhuoer Huang
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Xiangya School of Nursing, Central South University, Changsha, People’s Republic of China
| | - Jiaxin Liu
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Xiangya School of Nursing, Central South University, Changsha, People’s Republic of China
| | - Xiaoyuan Zheng
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
| | - Jing Tang
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Ying Wu
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
| | - Xiaohui Wang
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
| | - Yongzhen Liao
- Shunde Polytechnic, Foshan, People's Republic of China
| | - Li Cong
- School of Medicine, Hunan Normal University, Changsha, People’s Republic of China
- Correspondence: Li Cong, School of Medicine, Hunan Normal University, Changsha, People’s Republic of China, Tel/Fax +86-0731-88912446, Email
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Li D, Liu P, Zhang H, Wang L. The effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement. J Cardiothorac Surg 2021; 16:183. [PMID: 34172060 PMCID: PMC8229384 DOI: 10.1186/s13019-021-01437-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background To observe the effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement. Methods One hundred-thirty patients who underwent heart valve replacement surgery in our hospital from January 2018 to January 2020 were enrolled as the research subjects. They were randomly divided into study group (65 patients, phased written health education combined with health Diet) and control group (65 cases, routine health education). The drug compliance and the degree of anticoagulant drugs knowledge were compared between the two groups in the first and second stage rehabilitation and the recovery stage. The health behavior ability and quality of life at different phases were also observed. Results During the first and the second stage rehabilitation, and the recovery stage, the drug compliance of the study group was superior to that of the control group, with statistical significance (P < 0.05). Meanwhile, the knowledge of anticoagulant drugs in the study group was better than that in the control group, with statistical significance (P < 0.05). Before intervention, there was no significant difference in health behavior ability and quality of life between the two groups (P > 0.05). The healthy behavior ability of study group for each stage was superior to the control group, the difference was significant (P < 0.05). The healthy behavior ability and quality of life showed the same results with statistical significance (P < 0.05). Conclusion The use of phased written health education combined with healthy diet in patients after heart valve replacement can effectively improve patients’ medication compliance, anticoagulant drugs knowledge, healthy behavior ability and quality of life at different stages, and is worthy of clinical application.
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Affiliation(s)
- Dan Li
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pujuan Liu
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huijun Zhang
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Li Wang
- Functional Division, The Fourth Hospital of Hebei Medical University, No.169 Tianshan Street, Yuhua District, Shijiazhuang, 050000, Hebei, China.
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Blanch P, Freixa-Pamias R, Gambau M, Lafuente R, Basile L. Impact of an oral anticoagulation self-monitoring and self-management program in patients with mechanical heart valve prosthesis. J Comp Eff Res 2021; 10:307-314. [PMID: 33594899 DOI: 10.2217/cer-2020-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To analyze impact of implementation of an oral anticoagulation self-monitoring and self-management program among patients with mechanical valve prosthesis. Materials & methods: Observational and retrospective study performed in Hospital Moises Broggi, Barcelona, Spain. The program started on June 2019. The study compared 6-month period before and after the implementation of the program. Results: The study included 44 patients. There was a numerical increase of time in therapeutic range from 53.6 ± 21.3% to 57.1 ± 15.7% (p = 0.30). Proportion of patients with international normalized ratio (INR) >5 significantly decreased from 3.9 to 2.0% (p = 0.04). No significant differences were observed in thromboembolic or bleeding complications. Visits to emergency department decreased from (29.5 to 22.7%; p = 0.41). Conclusion: Oral anticoagulation self-monitoring and self-management program seems an appropriate approach that could provide additional benefits in selected patients with mechanical valve prosthesis.
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Affiliation(s)
- Pedro Blanch
- Department of Cardiology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Román Freixa-Pamias
- Department of Cardiology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Marta Gambau
- Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Raul Lafuente
- Department of Hematology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Luca Basile
- Department of Cardiology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain.,Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona, Spain
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Scherman J, Zilla P. Poorly suited heart valve prostheses heighten the plight of patients with rheumatic heart disease. Int J Cardiol 2020; 318:104-114. [DOI: 10.1016/j.ijcard.2020.05.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
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Stalikas N, Doundoulakis I, Karagiannidis E, Bouras E, Kartas A, Frogoudaki A, Karvounis H, Dimopoulos K, Giannakoulas G. Non-Vitamin K Oral Anticoagulants in Adults with Congenital Heart Disease: A Systematic Review. J Clin Med 2020; 9:E1794. [PMID: 32526897 PMCID: PMC7356004 DOI: 10.3390/jcm9061794] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 01/10/2023] Open
Abstract
Adults with congenital heart disease (ACHD) experience more thromboembolic complications than the general population. We systematically searched and critically appraised all studies on the safety and efficacy of non-vitamin-K oral anticoagulants (NOACs) in adult patients with various forms of congenital heart disease. PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were used, with duplicate extraction of data and risk of bias assessment. The Newcastle-Ottawa quality assessment scale was used to assess study quality. Three studies fulfilled the inclusion criteria and were analyzed. The total number of participants was 766, with a total follow-up of 923 patient-years. The majority of patients (77%) received a NOAC for atrial arrhythmias, while the remainder were prescribed NOACs for secondary (19%) or primary (4%) thromboprophylaxis. The annual rate of thromboembolic and major bleeding events was low: 0.98% (95% CI: 0.51-1.86) and 1.74% (95% CI: 0.86-3.49) respectively. In Fontan patients, the annual rate of thromboembolic and major bleeding events was 3.13% (95% CI: 1.18-8.03) and 3.17% (95% CI: 0.15-41.39) respectively. NOACs appear safe and effective in ACHD without mechanical prostheses. Additional studies are, however, needed to confirm their efficacy in complex ACHD, especially those with a Fontan-type circulation.
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Affiliation(s)
- Nikolaos Stalikas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54 636 Thessaloniki, Greece; (N.S.); (I.D.); (E.K.); (A.K.); (H.K.)
- Department of Internal Medicine, General Hospital of Edessa, 582 00 Proastio, Greece
| | - Ioannis Doundoulakis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54 636 Thessaloniki, Greece; (N.S.); (I.D.); (E.K.); (A.K.); (H.K.)
- Department of Cardiology, 424 General Military Training Hospital, 54 124 Thessaloniki, Greece
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54 636 Thessaloniki, Greece; (N.S.); (I.D.); (E.K.); (A.K.); (H.K.)
| | - Emmanouil Bouras
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, 54 124 Thessaloniki, Greece;
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54 636 Thessaloniki, Greece; (N.S.); (I.D.); (E.K.); (A.K.); (H.K.)
| | - Alexandra Frogoudaki
- Second Department of Cardiology, Attikon University Hospital, University of Athens, 124 62 Athens, Greece;
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54 636 Thessaloniki, Greece; (N.S.); (I.D.); (E.K.); (A.K.); (H.K.)
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College, London SW3 6NP, UK;
| | - George Giannakoulas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54 636 Thessaloniki, Greece; (N.S.); (I.D.); (E.K.); (A.K.); (H.K.)
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Zilla P, Bolman RM, Boateng P, Sliwa K. A glimpse of hope: cardiac surgery in low- and middle-income countries (LMICs). Cardiovasc Diagn Ther 2020; 10:336-349. [PMID: 32420116 PMCID: PMC7225428 DOI: 10.21037/cdt.2019.11.03] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
Currently, more than five times more people live in low- and middle-income countries (LMICs) than in high-income countries (HICs). As such, the downward trend in cardiac surgical needs in HICs reflects only the situation of one sixth of the world population while the vast majority living in LMICs has still no or limited access to life saving heart operations. In these countries, rheumatic heart disease (RHD) still accounts for a significant proportion of cardiac surgical needs. In low- and lower-middle income countries it remains the single most common cardiovascular disease in young adult and adolescent patients in need of heart surgery outweighing other indications such as congenital cardiac defects almost 4-fold. Compared to HICs with their predominance of calcific aortic stenosis in the elderly mitral valve surgery is required in >90% of the largely young patients with RHD in low-income countries (LICs) and still in 70% of the often middle aged patients in middle-income countries (MICs). Although recent government initiatives in LICs led to the establishment of local, independent cardiac surgical services gradually replacing fly-in missions, these centers still only cover less than 2% of the needs of their populations. In MICs, cardiac surgical needs continually grow with the emergence of degenerative diseases. As such, in spite of the concomitant growth of cardiac surgical capacity, significantly less than half the estimated patients in need have access. Capacities in LICs range from 0.5 to 7 cardiac operations/million population; 100-481/million in MICs and >1,200/million in HICs such as the USA and Germany. While a new level of awareness of the scope and magnitude of the problem has begun to emerge in LICs and the establishment of local cardiac surgical capacity has given rise to a glimpse of hope, the challenges of expanding these fledgling services to a significant proportion of the population still seem insurmountable. Challenges in MICs are on the other hand the widening gap between private cardiac medicine for the affluent few and overwhelmed public services for the many and the rural urban divide with the underappreciation of the ongoing dominance of RHD in the rural and indigent population on the other. Overshadowing all LMICs is the low level of valve-repair skills associated with insufficient cardiac surgical capacity and the unavailability of suitable replacement valves which address the young age of the patients and the difficulties of anticoagulation in a socioeconomic environment distinctly different from the elderly patients of HICs.
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Affiliation(s)
- Peter Zilla
- Christian Barnard Department for Cardiothoracic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - R. Morton Bolman
- Anschutz Medical Campus, University of Colorado Denver, Aurora and University of Colorado, Denver, CO, USA
| | - Percy Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, NY, USA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Riva N, Borg Xuereb C, Makris M, Ageno W, Gatt A. Reliability and validity of the Maltese version of the Perception of Anticoagulant Treatment Questionnaire (PACT-Q). Patient Prefer Adherence 2019; 13:969-979. [PMID: 31417242 PMCID: PMC6593733 DOI: 10.2147/ppa.s207498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/12/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose: Anticoagulant therapy has an impact on the health-related quality of life, as it is a chronic treatment for most clinical indications and also requires some lifestyle changes. Since there was no validated questionnaire available in the Maltese language, the aim of our study was to translate and validate the Perception of Anticoagulant Treatment Questionnaire (PACT-Q2). Patients and methods: The PACT-Q2 explores two dimensions (convenience and anticoagulant treatment satisfaction). Forward and backward translations were performed. The Maltese version of the PACT-Q2 was administered to 174 patients on warfarin treatment enrolled from different anticoagulation clinics in Malta. Reliability was assessed through internal consistency (Cronbach's alpha) and test-retest (intraclass correlation coefficient [ICC]). Validity was assessed through floor/ceiling effect, factor analysis (root mean square error of approximation [RMSEA], standardized root mean squared residual [SRMR], goodness-of-fit index [GFI], adjusted goodness-of-fit index [AGFI], comparative fit index [CFI]), subscales correlation and known-group validity. Results: Reliability was very good for the convenience subscale (Cronbach's alpha 0.86, ICC 0.87), but less good for the satisfaction subscale (Cronbach's alpha 0.62, ICC 0.40). Floor effect was 0%; ceiling effect was low (6.3% convenience, 1.2% satisfaction). Fit parameters were close to acceptable cut-offs (RMSEA =0.09, SRMR =0.10, GFI =0.82, AGFI =0.78, CFI =0.79). There was no correlation between the two subscales (r=0.01, p=0.83). Patients with history of bleeding showed lower convenience (r=-0.16, p=0.08) and lower satisfaction (r=-0.21, p=0.01). Conclusions: Our results support the finding that the Maltese translation of the PACT-Q2 is a valid and reliable instrument.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Correspondence: Nicoletta RivaDepartment of Pathology, Faculty of Medicine and Surgery, University of Malta, MsidaMSD 2080, MaltaTel +3 562 545 2518Fax +3 562 545 0000Email
| | - Christian Borg Xuereb
- Department of Gerontology and Dementia Studies, Faculty for Social Wellbeing, University of Malta, Msida, Malta
| | - Michael Makris
- Sheffield Haemophilia and Thrombosis Centre, University of Sheffield, Sheffield, UK
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Keenan NM, Newland RF, Baker RA, Rice GD, Bennetts JS. Outcomes of Redo Valve Surgery in Indigenous Australians. Heart Lung Circ 2018; 28:1102-1111. [PMID: 30139596 DOI: 10.1016/j.hlc.2018.05.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/13/2018] [Accepted: 05/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rheumatic heart disease often leads to valve surgery at a young age in our Indigenous population. Anticoagulation can be problematic and therefore repeat surgery to replace degenerated bioprosthetic valves is common. We sought to examine outcomes following redo valve surgery in this population. METHODS Data from our institutional database was reviewed from 1992 to 2017. During this period, 82 redo valve surgeries were performed in 73 patients identifying as Aboriginal and Torres Strait Islander. We compared this study group to Indigenous patients undergoing primary valve surgery (n=389) and non-Indigenous patients undergoing redo valve surgery (n=154). RESULTS Redo patients had a median age of 29.5 years (IQR 24, 44), 59% were female, and they had significant comorbidities. The 30-day mortality in this cohort was 6% (EuroSCORE II 3.57), and they had significant morbidity. The median time to repeat surgery in those who had previous mitral valve surgery was 6.3 years, with no difference between mitral valve repair or replacement at the index procedure. Compared to non-Indigenous patients undergoing redo valve surgery, the Indigenous patients were significantly younger with higher left ventricular function but a greater proportion of pulmonary hypertension. There were no significant differences in short-term outcomes. Compared to Indigenous patients undergoing primary valve surgery, the Indigenous redo patients were significantly younger with more co-morbidities. There was no difference in 30-day mortality, but the redo patients did have significantly greater resource utilisation (increased hospital and intensive care unit (ICU) lengths of stay, ventilation and blood transfusion) and poorer long-term survival. CONCLUSIONS Indigenous patients presenting for redo valve surgery represent a complex and comorbid group of patients, with outcomes worse than expected in a young population, albeit comparable within study groups. Time from original surgery was short at 6 years, and thus a strategy must be in place in terms of planning future surgeries in this cohort of predominantly young rheumatic heart disease patients.
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Affiliation(s)
| | - Richard F Newland
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia
| | - Robert A Baker
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia
| | | | - Jayme S Bennetts
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia.
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11
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Gallagher R, Potter E, Thomson Mangnall L, Ladak L, Gallagher P, Neubeck L. The power in being together for young adults who have heart disease - the photoshoot experience. Heart Lung 2017; 46:199-204. [PMID: 28366291 DOI: 10.1016/j.hrtlng.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study aimed to determine perceived motivations and benefits of photoshoot participation for young adults who have heart disease. BACKGROUND Feeling isolated and different can have lifelong affects on quality of life in heart disease survivors. Photoshoots, where people create a photographic image of themselves, promote positive interpretation of their cardiac illness experience, but participant experiences remain under-investigated. METHODS Young adult heart disease support group members completing a photoshoot were interviewed and data were thematically analyzed. RESULTS Seven females and one male aged 20-47 years participated. The main theme, People Like Me, emphasized feelings of being different, isolated and uncertain due to the heart disease. Other themes related to support gained from people who were not like them, gaining and providing support to their peers. The photoshoot enabled a highly valued collective feeling. CONCLUSIONS For young adult heart disease survivors, the photoshoot provides a fun, social opportunity to reduce isolation and share experiences.
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Affiliation(s)
- Robyn Gallagher
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia; Faculty of Health, University of Technology, Sydney, 15 Broadway, Ultimo, NSW 2007, Australia.
| | - Ellen Potter
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia
| | - Linda Thomson Mangnall
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia; Cardiac Telemetry Unit, Sydney Adventist Hospital, 185 Fox Valley Rd Wahroonga, NSW 2076, Australia
| | - Laila Ladak
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia
| | | | - Lis Neubeck
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Rm 2210, Lvl 2, Bld 17, Camperdown, NSW 2007, Australia; The George Institute of Global Health, Lvl 3, 50 Bridge St, Sydney, NSW 2000, Australia
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12
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Nandra TK, Wilson NJ, Artrip J, Pagis B. Rheumatic fever with severe carditis: still prevalent in the South West Pacific. BMJ Case Rep 2017; 2017:bcr-2016-218954. [PMID: 28283470 DOI: 10.1136/bcr-2016-218954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rheumatic heart disease (RHD) has a worldwide prevalence of 33 million cases and 270 000 deaths annually, making it the most common acquired heart disease in the world. There is a disparate global burden in developing countries. This case report aims to address the minimal RHD coverage by the international medical community. A Tahitian boy aged 10 years was diagnosed with advanced heart failure secondary to RHD at a local clinic. Previous, subtle symptoms of changes in handwriting and months of fever had gone unrecognised. Following a rapid referral to the nearest tertiary centre in New Zealand, urgent cardiac surgery took place. He returned home facing lifelong anticoagulation. This case highlights the RHD burden in Oceania, the limited access to paediatric cardiac services in countries where the RHD burden is greatest and the need for improved awareness of RHD by healthcare professionals, and the general public, in endemic areas.
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Affiliation(s)
| | | | - John Artrip
- Auckland City Hospital, Auckland, New Zealand
| | - Bruno Pagis
- Centre Hospitalier de la Polynesie Francaise, Papeete, French Polynesia
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