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Fialka NM, Watkins AR, Alam A, EL-Andari R, Kang JJH, Hong Y, Bozso SJ, Moon MC, Nagendran J. Tissue versus mechanical mitral valve replacement in patients aged 50-70: a propensity-matched analysis. Eur J Cardiothorac Surg 2024; 66:ezae283. [PMID: 39167084 PMCID: PMC11344592 DOI: 10.1093/ejcts/ezae283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/08/2024] [Accepted: 08/19/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVES There remains debate over the optimal mitral valve replacement (MVR) option for patients aged 50-70 years. The objective of this study was to retrospectively compare the long-term outcomes of mechanical and bioprosthetic MVR in this patient population. METHODS Data from patients undergoing MVR between 2004 and 2018 were retrospectively reviewed. The primary outcome was all-cause mortality. Secondary outcomes included perioperative and late morbidity. RESULTS Two hundred and eight-six propensity-matched patients (n = 143 mechanical; n = 143 bioprosthetic) aged 50-70 years were included in the final analysis. Maximum follow-up was 15.8 years. There was no significant difference in all-cause mortality between the groups at 30 days, 1 year, 5 years, 10 years, and at the longest follow-up. Patients who underwent mechanical MVR experienced significantly lower rates of postoperative atrial fibrillation (P = 0.001). There were no significant differences in rates of sepsis, acute kidney injury, superficial and deep sternal wound infection, mediastinal bleeding, and permanent pacemaker implantation. At the longest follow-up, there were no differences in myocardial infarction, stroke, heart failure or overall rehospitalization. At the same time point, there was an increased rate of MVR in patients receiving a bioprosthetic valve (P = 0.015). CONCLUSIONS Survival following mechanical and bioprosthetic MVR in patients 50-70 years of age is similar to up to 15 years of follow-up. Bioprosthetic MVR is associated with an increased risk of repeat MVR. Mechanical MVR is not associated with an increased risk of stroke. Valve selection in this patient population requires diligent consideration of structural valve deterioration and subsequent reoperation risk as well as bleeding and thromboembolic risk.
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Affiliation(s)
- Nicholas M Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Abeline R Watkins
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Abrar Alam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ryaan EL-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jimmy J H Kang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Wang X, Wu Y, Li M, Wen J, Liu L, Huang W, He Q, Liao Y, Cong L. Effective health management strategies for patients undergoing valve replacement: a bibliometric analysis of the current research status and future directions. Front Cardiovasc Med 2024; 11:1352437. [PMID: 38476380 PMCID: PMC10929617 DOI: 10.3389/fcvm.2024.1352437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Background Valvular heart disease is a major health concern worldwide. The effective management of patients undergoing valve replacement determines their prognosis. Bibliometric analysis of studies on managing patients with artificial heart valves has not been previously performed. Methods This study analyzed 2,771 publications related to patient management after valve replacement published in the Web of Science Core Collection database between January 1, 2013, and December 31, 2022. Bibliometric analysis was performed using CiteSpace and VOSviewer considering countries, institutions, authors, journals, references, and keywords. Results The countries with the most significant contributions in this field were the United States of America (USA), Germany, and Italy. Leon MB from Columbia University, USA was the most influential author. Transcatheter aortic valve replacement was a current research hotspot, while anticoagulation management was a key area of interest. Combining anticoagulation therapy with internet-linked tools and portable health devices may offer new research avenues. Frailty assessment and intervention were potential future research areas. Conclusions This bibliometric analysis provides clinicians and researchers with useful insights for developing novel ideas and directions to manage the health of patients undergoing valve replacement.
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Affiliation(s)
- Xiaohui Wang
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Ying Wu
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Ming Li
- Trauma Center, Zhu Zhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Jing Wen
- Nursing Department, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Lijuan Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wenzhuo Huang
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qianqian He
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | | | - Li Cong
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
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3
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Wu Y, Wang X, Zhou M, Huang Z, Liu L, Cong L. Application of eHealth Tools in Anticoagulation Management After Cardiac Valve Replacement: Scoping Review Coupled With Bibliometric Analysis. JMIR Mhealth Uhealth 2024; 12:e48716. [PMID: 38180783 PMCID: PMC10799280 DOI: 10.2196/48716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/20/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Anticoagulation management can effectively prevent complications in patients undergoing cardiac valve replacement (CVR). The emergence of eHealth tools provides new prospects for the management of long-term anticoagulants. However, there is no comprehensive summary of the application of eHealth tools in anticoagulation management after CVR. OBJECTIVE Our objective is to clarify the current state, trends, benefits, and challenges of using eHealth tools in the anticoagulation management of patients after CVR and provide future directions and recommendations for development in this field. METHODS This scoping review follows the 5-step framework developed by Arksey and O'Malley. We searched 5 databases such as PubMed, MEDLINE, Web of Science, CINAHL, and Embase using keywords such as "eHealth," "anticoagulation," and "valve replacement." We included papers on the practical application of eHealth tools and excluded papers describing the underlying mechanisms for developing eHealth tools. The search time ranged from the database inception to March 1, 2023. The study findings were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Additionally, VOSviewer (version 1.6.18) was used to construct visualization maps of countries, institutions, authors, and keywords to investigate the internal relations of included literature and to explore research hotspots and frontiers. RESULTS This study included 25 studies that fulfilled the criteria. There were 27,050 participants in total, with the sample size of the included studies ranging from 49 to 13,219. The eHealth tools mainly include computer-based support systems, electronic health records, telemedicine platforms, and mobile apps. Compared to traditional anticoagulation management, eHealth tools can improve time in therapeutic range and life satisfaction. However, there is no significant impact observed in terms of economic benefits and anticoagulation-related complications. Bibliometric analysis suggests the potential for increased collaboration and opportunities among countries and academic institutions. Italy had the widest cooperative relationships. Machine learning and artificial intelligence are the popular research directions in anticoagulation management. CONCLUSIONS eHealth tools exhibit promise for clinical applications in anticoagulation management after CVR, with the potential to enhance postoperative rehabilitation. Further high-quality research is needed to explore the economic benefits of eHealth tools in long-term anticoagulant therapy and the potential to reduce the occurrence of adverse events.
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Affiliation(s)
- Ying Wu
- Center for Moral Culture, Hunan Normal University, Changsha, China
- School of Medicine, Hunan Normal University, Changsha, China
| | - Xiaohui Wang
- School of Medicine, Hunan Normal University, Changsha, China
| | - Mengyao Zhou
- School of Medicine, Hunan Normal University, Changsha, China
| | - Zhuoer Huang
- School of Medicine, Hunan Normal University, Changsha, China
| | - Lijuan Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Li Cong
- School of Medicine, Hunan Normal University, Changsha, China
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Carrel T, Vogt PR, Obrist D, Schaff H. Evolving technology: the TRIFLO tri-leaflet mechanical valve without oral anticoagulation: a potential major innovation in valve surgery. Front Cardiovasc Med 2023; 10:1220633. [PMID: 37840955 PMCID: PMC10570810 DOI: 10.3389/fcvm.2023.1220633] [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: 05/10/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
The aortic valve is the most frequently diseased valve and aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. The diseased native aortic valve can be replaced by either a biological or mechanical valve prosthesis. The main concerns relate to durability, the need for oral anticoagulants and the incidence of complications related to this medication. Experimental, computational and biomolecular blood flow studies have demonstrated that the systolic forward flow but also the reverse flow phase at the end of the systole and leakage during the diastolic phase is mainly responsible for platelet activation and thrombosis. Better design of mechanical prosthetic heart valves must ensure smooth closing during flow deceleration and must eliminate high-shear hinge flow during diastole to prevent life-threatening thrombosis. A novel tri-leaflet valve should combine the favorable hemodynamics and the durability of existing mechanical heart valves and eliminate the less favorable characteristics, including the extremely rapid closing. In this paper, we discuss some issues of current mechanical heart valve prostheses and present a new valve design with the potential for significant innovation in the field. The TRIFLO Heart Valve, is a rigid, three-leaflet central flow heart valve prosthesis consisting of an alloyed titanium housing, and three rigid polymer (PEEK) cusps. This valve has a physiological operating mode. During the forward flow phase, the intraventricular pressure opens the leaflets so that blood can freely flow through with little obstruction, and with the deceleration of the blood flow, the leaflets close early and smoothly, minimizing blood flow regurgitation, blood cell damage, and activation of the coagulation cascade. Pre-clinical studies have shown pretty favorable results and a first-in-man study should start very soon.
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Affiliation(s)
- Thierry Carrel
- Department of Cardiac Surgery, University Hospital Basel, Switzerland
| | | | - Dominique Obrist
- ARTORG Center for Biomedical Research, University of Bern, Bern, Switzerland
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Geng L, Gu J, Li M, Liu H, Sun H, Ni B, Gu W, Shao Y, Li M, Chen M. Frequency of prothrombin time-international normalized ratio monitoring and the long-term prognosis in patients with mechanical valve replacement. BMC Cardiovasc Disord 2023; 23:322. [PMID: 37355558 PMCID: PMC10290782 DOI: 10.1186/s12872-023-03293-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/11/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND The study aimed to assess the correlation between the monitoring frequency of PT-INR and the long-term prognosis in patients with mechanical heart valve (MHV) replacement after discharge. METHODS This single-center, observational study enrolled patients who underwent MHV replacement and discharged from June 2015 to May 2018. Patients or their corresponding family members were followed with a telephone questionnaire survey in July-October 2020. Based on monitoring intervals, patients were divided into frequent monitoring (FM) group (≤ 1 month) and less frequent monitoring (LFM) group (> 1 month). The primary endpoint was the composite of thromboembolic event, major bleeding or all-cause death. The secondary endpoints were thromboembolic event, major bleeding or all-cause death, respectively. RESULTS A total of 188 patients were included in the final analysis. The median follow-up duration was 3.6 years (Interquartile range: 2.6 to 4.4 years). 104 (55.3%) patients and 84 (44.7%) patients were classified into the FM group and the LFM group, respectively. The FM group had a significantly lower incidence of the primary endpoint than the LFM group (3.74 vs. 1.16 per 100 patient-years, adjusted HR: 3.31 [95% CI 1.05-10.42, P = 0.041]). Secondary analysis revealed that the risk of thromboembolic events and all-cause death were also reduced in the FM group. CONCLUSIONS The management of warfarin treatment in patients after MHV replacement remains challenging. Patients with less frequent monitoring of PT-INR might have worse clinical prognosis than those with frequent PT-INR monitoring.
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Affiliation(s)
- Le Geng
- Division of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China
| | - Jiaxi Gu
- Division of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China
| | - Minghui Li
- Division of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China
| | - Hong Liu
- Division of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China
| | - Haoliang Sun
- Division of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China
| | - Buqing Ni
- Division of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China
| | - Weidong Gu
- Division of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China
| | - Yongfeng Shao
- Division of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China.
| | - Mingfang Li
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China.
| | - Minglong Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, P.R. China
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Ferreira L, Almeida R, Arantes A, Abdulazeem H, Weeraseka I, Ferreira L, Messias L, Couto L, Martins MA, Antunes N, Cândido R, Ferreira S, Assis T, Pedroso T, Boersma E, Ribeiro AL, Marcolino M. Telemedicine-based management of oral anticoagulation therapy: a systematic review and meta-analysis (Preprint). J Med Internet Res 2023. [PMID: 37428532 PMCID: PMC10366670 DOI: 10.2196/45922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. OBJECTIVE The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulation management compared to usual care on thromboembolic and bleeding events. METHODS Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection and data extraction. Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. RESULTS In total, 25 randomized controlled trials were included (n=25,746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (n=13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I2=42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=90%). In the subgroup of the multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48). CONCLUSIONS Telemedicine-based oral anticoagulation management resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events, and better anticoagulation quality compared to standard care. Given the potential benefits of telemedicine-based care, such as greater access to remote populations or people with ambulatory restrictions, these findings may encourage further implementation of eHealth strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases. Meanwhile, researchers should develop higher-quality evidence focusing on hard clinical outcomes, cost-effectiveness, and quality of life. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208.
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Huang Y, Xie Y, Huang L, Han Z. The Value of Anticoagulation Management Combining Telemedicine and Self-Testing in Cardiovascular Diseases: A Meta-Analysis of Randomized Controlled Trials. Ther Clin Risk Manag 2023; 19:279-290. [PMID: 36941980 PMCID: PMC10024473 DOI: 10.2147/tcrm.s395578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
PURPOSE No consensus has been established on the safety and effectiveness of out-of-hospital management of Vitamin K antagonists (VKA) therapy combining portable coagulometers and telemedicine. The present meta-analysis investigated the safety and effectiveness of this hybrid anticoagulants management model. METHODS The PubMed, Embase, Cochrane, and Web of Science databases were searched for papers published before May 1, 2022. To reduce bias, only randomized controlled trials were included. RevMan 5.3 (Cochrane) software was used to evaluate and analyze clinical outcomes, including the effectiveness and safety of patient management approaches, determined by the time in the therapeutic range (TTR) and occurrence of thrombotic and bleeding events. RESULTS Eight studies, comprising 3853 patients, were selected. The meta-analysis showed that anticoagulant management combining portable coagulometers and telemedicine significantly improved frequency of testing (mean difference [MD]= 12.95 days; 95% CI, 8.77-17.12; I2= 92%; P< 0.01) and TTR (MD= 9.50%; 95% CI, 3.16-15.85; I2= 87%; P< 0.01). Thromboembolism events were reduced (RR= 0.72; 95% CI, 0.51-1.01; I2= 0%; P= 0.05), but the results were not statistically significant. And no significant differences in major bleeding events, rehospitalization rate, mortality, or overall treatment cost existed between the two groups. CONCLUSION Although the safety of remote cardiovascular disease management is not superior to that of conventional outpatient anticoagulant management, it provides a more stable monitoring of coagulation status.
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Affiliation(s)
- Yu Huang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Guangdong, 518036, People’s Republic of China
- Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Yilian Xie
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Guangdong, 518036, People’s Republic of China
- Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of China
| | - Lei Huang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Guangdong, 518036, People’s Republic of China
| | - Zhen Han
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Guangdong, 518036, People’s Republic of China
- Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
- Correspondence: Zhen Han, Email
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Peng W, Wang Y, Zhang Y, Lin Y. Concomitant administration of warfarin and toremifene: A case report. J Clin Pharm Ther 2022; 47:2383-2386. [PMID: 36443538 DOI: 10.1111/jcpt.13815] [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: 06/30/2022] [Revised: 10/20/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Antiestrogen agents have been reported to enhance the anticoagulant activity of warfarin. The use of tamoxifen with warfarin has been contraindicated. However, warfarin in combination with toremifene has not been reported. We report a case in which warfarin was combined with toremifene and applied warfarin dose prediction models to predict the dose of warfarin. CASE SUMMARY We report the case of a 50-year-old woman with a history of breast cancer, who underwent long-term toremifene therapy after mastectomy. The patient was treated with warfarin after prosthetic valve replacement and had a fluctuating international normalized ratio (INR) following the concomitant administration of toremifene. We applied the warfarin dose prediction model to adjust the warfarin dose during treatment. Finally, her INR stabilized with a lower dose of warfarin, and there was no serious bleeding during the 1-year follow-up. WHAT IS NEW AND CONCLUSION Warfarin does not have a serious interaction with toremifene in this case, but it needed about 37.5% dose reduction which was comparable to the interaction of some common antibiotics with warfarin.
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Affiliation(s)
- Wenxing Peng
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yifan Wang
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,College of Pharmacy, Capital Medical University, Beijing, China
| | - Yunnan Zhang
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,College of Pharmacy, Capital Medical University, Beijing, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Huang Y, Huang L, Han Z. Combining portable coagulometers with the Internet: A new model of warfarin anticoagulation in patients following mechanical heart valve replacement. Front Surg 2022; 9:1016278. [PMID: 36311931 PMCID: PMC9608170 DOI: 10.3389/fsurg.2022.1016278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Heart valve replacement, as a safe and effective treatment for severe valvular heart disease, can significantly improve hemodynamics in patients. However, such patients then require lifelong anticoagulant therapy. Warfarin, a cheap and highly effective vitamin K antagonist, remains the major anticoagulant recommended for lifelong use following mechanical heart valve replacement. However, the effect of warfarin anticoagulant therapy is complicated by physiological differences among patients and non-compliance with treatment at different degrees. Effective management of warfarin therapy after heart valve replacement is currently an important issue. Portable coagulometers and the emergence of the Internet have provided new opportunities for long-term management of anticoagulation therapy, but the safety and affordability of this approach remain to be fully evaluated. This paper reviews recent progress on the use of portable coagulometers and the Internet in the management of warfarin anticoagulation therapy following mechanical heart valve replacement, which offers opportunities for reducing complications during postoperative anticoagulation and for facilitating patient compliance during follow-up.
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10
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Jiang F, Lin Y, Li S, Peng Y, Huang X, Chen L. A Study of the Nursing Intervention Based on Self-Efficacy Theory for Patients After Mechanical Heart Valve Replacement: A Randomized Controlled Trial. Int J Gen Med 2022; 15:6539-6547. [PMID: 35971525 PMCID: PMC9375546 DOI: 10.2147/ijgm.s353977] [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: 12/14/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Aim To explore the practicability and efficiency of self-efficacy intervention on the nursing for patients after mechanical heart valve replacement (MHVR), so as to provide a theoretical and data foundation for the implementation of self-efficacy intervention in clinical practice. Methods This study adopted a randomized controlled trial (RCT). A total of 140 patients undergoing MHVR were randomly divided into the experimental group (normal nursing + self-efficacy intervention) or the control group (normal nursing only) based on a random number table. The primary goal was to evaluate the effect of self-efficacy theory on the self-efficacy of postoperative MHVR patients by General Self-Efficacy Scale (GSES). The secondary goal was to assess the improvement of mental health of postoperative patients as well as their pain through Symptom Checklist 90 (SCL-90) and the visual analogue scale (VAS). The incidence of infection during hospitalization was analyzed, as well as the medication compliance of patients during 3-month follow-up after discharge. Results Finally, 136 patients completed the whole trial. The GSES score of the experimental group was notably superior over the control group (p < 0.001), and the SCL-90 scores were lower over the control group. The VAS score of the experimental group was remarkably lower than that of the control group (p < 0.001). The incidence of infection in the experimental group was lower than that in the control group (p = 0.026). The medication compliance of the experimental group was superior to that of the control group (p = 0.030). Conclusion Self-efficacy intervention for patients after MHVR could mobilize their self-efficacy, enhance their postoperative medication compliance, and improve their postoperative recovery. This study provides evidence-based medicine (EBM) evidence for the application of self-efficacy theory to postoperative nursing for patients receiving MHVR.
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Affiliation(s)
- Fei Jiang
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Yanjuan Lin
- Nursing Department, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Sailan Li
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Yanchun Peng
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Xizhen Huang
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Liangwan Chen
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
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Ni R, Liu M, Huang S, Yang J. Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40090. [PMID: 35972792 PMCID: PMC9428777 DOI: 10.2196/40090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression. OBJECTIVE The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice. METHODS We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI -0.03 to 0.24, I2=46.4%, P=.14). The control group's score was lower than that of the intervention group for the depression outcomes (MD -0.53, 95% CI -0.89 to -0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low. CONCLUSIONS eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required. TRIAL REGISTRATION PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305.
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Affiliation(s)
- Ruping Ni
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Shunmin Huang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jing Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, 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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