The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy

Lo, Flora M W; Wong, Eliza Lai Yi; Hong, Felix K W

doi:10.1097/jcn.0000000000000790

Cited by 3 publications

References 52 publications

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The Efficacy of the Smart-Rehabilitation Program in Patients After the Correction of Valvular Heart Diseases

et al. 2023

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Aim Comparative analysis of the effectiveness of a new approach, "SMART rehabilitation of patients after heart valve replacement", which includes, in addition to face-to-face training, Internet technologies in the form of video conferencing, the mobile application "Calculation of the warfarin dose", and a traditional program for educating patients after correction of valvular defects.Material and methods The study included 190 patients with prosthetic heart valves. The main group consisted of 98 patients who completed a distance learning course. The control group included 92 patients participating in face-to-face training. Clinical and instrumental examinations (electrocardiography, echocardiography, determination of international normalized ratio (INR)), and surveys to evaluate awareness, compliance with treatment, and quality of life (QoL) were performed.Results At baseline, the awareness, compliance and QoL did not differ between the compared groups. After 6-month follow-up, the mean score of awareness increased by 53.6 % (р=0.0001). The compliance with treatment increased 3.3 times in the main group and 1.7 times in the control group (p=0.0247). Patients of the main group were more prone to self-management (p=0.0001), had better medical and social awareness (p=0.0335), medical and social communicability (p=0.0392), confidence in the therapeutic strategy of the attending physician (p=0.0001), and treatment effectiveness (p=0.0057). Analysis of QoL showed increases in living activity 2.1 times (р=0.0001), social functioning 1.6 times (р=0.0001), and mental health 1.9 times (р=0.0001).Conclusion The novel approach of distance learning, "SMART rehabilitation of patients after heart valve replacement", provides improvements in awareness, compliance with treatment and QoL.

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The Efficacy of the Smart-Rehabilitation Program in Patients After the Correction of Valvular Heart Diseases

et al. 2023

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New Internet-Based Warfarin Anticoagulation Management Approach After Mechanical Heart Valve Replacement: Prospective, Multicenter, Randomized Controlled Trial

Zhu¹,

Li²,

Shen³

et al. 2021

J Med Internet Res

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Background Mechanical heart valve replacement (MHVR) is an effective method for the treatment of severe heart valve disease; however, it subjects patient to lifelong warfarin therapy after MHVR with the attendant risk of bleeding and thrombosis. Whether internet-based warfarin management reduces complications and improves patient quality of life remains unknown. Objective This study aimed to compare the effects of internet-based warfarin management and the conventional approach in patients who received MHVR in order to provide evidence regarding alternative strategies for long-term anticoagulation. Methods This was a prospective, multicenter, randomized, open-label, controlled clinical trial with a 1-year follow-up. Patients who needed long-term warfarin anticoagulation after MHVR were enrolled and then randomly divided into conventional and internet-based management groups. The percentage of time in the therapeutic range (TTR) was used as the primary outcome, while bleeding, thrombosis, and other events were the secondary outcomes. Results A total of 721 patients were enrolled. The baseline characteristics did not reach statistical differences between the 2 groups, suggesting the random assignment was successful. As a result, the internet-based group showed a significantly higher TTR (mean 0.53, SD 0.24 vs mean 0.46, SD 0.21; P<.001) and fraction of time in the therapeutic range (mean 0.48, SD 0.22 vs mean 0.42, SD 0.19; P<.001) than did those in the conventional group. Furthermore, as expected, the anticoagulation complications, including the bleeding and embolic events had a lower frequency in the internet-based group than in the conventional group (6.94% vs 12.74%; P=.01). Logistic regression showed that internet-based management increased the TTR by 7% (odds ratio [OR] 1.07, 95% CI 1.05-1.09; P<.001) and reduced the bleeding and embolic risk by 6% (OR 0.94, 95% CI 0.92-0.96; P=.01). Moreover, low TTR was found to be a risk factor for bleeding and embolic events (OR 0.87, 95% CI 0.83-0.91; P=.005). Conclusions The internet-based warfarin management is superior to the conventional method, as it can reduce the anticoagulation complications in patients who receive long-term warfarin anticoagulation after MHVR. Trial Registration Chinese Clinical Trial Registry ChiCTR1800016204; http://www.chictr.org.cn/showproj.aspx?proj=27518 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-032949

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New Internet-Based Warfarin Anticoagulation Management Approach After Mechanical Heart Valve Replacement: Prospective, Multicenter, Randomized Controlled Trial (Preprint)

Zhu¹,

Li²,

Shen³

et al. 2021

Preprint

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BACKGROUND Mechanical heart valve replacement (MHVR) is an effective method for the treatment of severe heart valve disease, while the patient who was administered with warfarin therapy after MHVR facing a high risk of bleeding and thrombosis. Therefore, as internet-based warfarin management emerged, whether it reduces the complications and improves patient’s life quality remain unknown. OBJECTIVE This study aimed to compare effects of internet-based warfarin management and conventional approach in patients who received MHVR. In order to provide evidence regarding alternative strategies for a long-term anticoagulation. METHODS This is a prospective, multicenter, randomized, open-label, controlled clinical trial with a follow-up for 1 year. Patients who need long-term warfarin anticoagulation after MHVR were enrolled, then randomly divided into traditional and internet-based management group. The percentage of time in the therapeutic range (TTR) was used as the primary outcome, and the bleeding, thrombosis and other event as secondary outcome. RESULTS A total of 721 patients were enrolled and the baseline is not reach statistical different between the two groups, suggesting the random assignment is successful. As a result, the internet-based group showed a significantly higher TTR (0.53±0.24 vs. 0.46±0.21, P<0.01) and fraction of time in therapeutic range (FTTR, 0.48±0.22 vs. 0.42±0.19, P<0.01), than those in the traditional group. Furthermore, as expected, the anticoagulation complications, including the bleeding and embolic events (6.94% vs. 12.74%, P<0.01) have lower frequency in the internet-based group than in the traditional group. Logistic regression shows that internet-based management increased the TTR by 7% (OR=1.07, 95%CL 1.05-1.09, P<0.01), and reduced the bleeding and embolic risk by 6% (OR=0.94, 95%CL 0.92-0.96, P<0.05). Moreover, low TTR is the risk factor of bleeding and embolic events (OR=0.87, 95%CL 0.83-0.91, P<0.05) CONCLUSIONS The internet-based warfarin management is superior than the traditional way by reducing the anticoagulation complications in patients who received long-term warfarin anticoagulation after MHVR. CLINICALTRIAL ChiCTR1800016204; http://www.chictr.org.cn/showproj.aspx?proj=27518 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2019-032949

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The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy

Cited by 3 publications

References 52 publications

The Efficacy of the Smart-Rehabilitation Program in Patients After the Correction of Valvular Heart Diseases

The Efficacy of the Smart-Rehabilitation Program in Patients After the Correction of Valvular Heart Diseases

New Internet-Based Warfarin Anticoagulation Management Approach After Mechanical Heart Valve Replacement: Prospective, Multicenter, Randomized Controlled Trial

New Internet-Based Warfarin Anticoagulation Management Approach After Mechanical Heart Valve Replacement: Prospective, Multicenter, Randomized Controlled Trial (Preprint)

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