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Zhang X, Huang X, Peng Y, Huang L, Lin L, Chen L, Lin Y. Mediating effects of general self-efficacy on social support and quality of life in patients after surgical aortic valve replacement. Nurs Open 2023; 10:6935-6944. [PMID: 37475145 PMCID: PMC10495726 DOI: 10.1002/nop2.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/19/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
AIM To explore whether general self-efficacy can mediate the relationship between social support and quality of life in patients after surgical aortic valve replacement. DESIGN A cross-sectional design. METHODS The final analysis included 283 patients who underwent surgical aortic valve replacement from May 2021 to September 2021. They completed a set of questionnaires, including the Chinese version of the General Self-Efficacy Scale, the Chinese Questionnaire of Quality of life in Patients with Cardiovascular Diseases and the Social Support Rating Scale. The PROCESS Macro in SPSS was used to analyse the mediating effect. RESULTS Quality of life and all of its dimensions were significantly related to social support and general self-efficacy. A significant indirect effect of social support existed through general self-efficacy in relation to quality of life with the mediation effect ratio of 32.82%.
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Affiliation(s)
- Xuecui Zhang
- The School of NursingFujian Medical UniversityFuzhouChina
| | - Xizhen Huang
- Department of Cardiovascular Surgery, Union HospitalFujian Medical UniversityFuzhouChina
| | - Yanchun Peng
- Department of Nursing, Union HospitalFujian Medical UniversityFuzhouChina
| | - Long Huang
- The School of NursingFujian Medical UniversityFuzhouChina
| | - Lingyu Lin
- Department of Cardiovascular Surgery, Union HospitalFujian Medical UniversityFuzhouChina
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Union HospitalFujian Medical UniversityFuzhouChina
- Key Laboratory of Cardio‐Thoracic SurgeryFujian Medical University, Fujian Province UniversityFuzhouChina
| | - Yanjuan Lin
- Department of Cardiovascular Surgery, Union HospitalFujian Medical UniversityFuzhouChina
- Department of Nursing, Union HospitalFujian Medical UniversityFuzhouChina
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Long-Term Outcome Up To 40 Years after Single Patch Repair of Complete Atrioventricular Septal Defect in Infancy or Childhood. Thorac Cardiovasc Surg 2021; 69:e68-e75. [PMID: 34953470 PMCID: PMC8751973 DOI: 10.1055/s-0041-1740070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives Patients with repaired complete atrioventricular septal defect (CAVSD)
represent an increasing portion of grown-ups with congenital heart disease. For repair of
CAVSD, the single-patch technique has been employed first. This technique requires
division of the bridging leaflets, thus, among other issues, long-term function of the
atrioventricular valves is of particular concern. Methods Between 1978 and 2001, 100 consecutive patients with isolated CAVSD
underwent single-patch repair in our institution. Hospital mortality was 11%. Primary
endpoints were clinical status, atrioventricular valve function, and freedom from
reoperation in long term. Follow-up was obtained contacting the patient and/or caregiver,
and the referring cardiologist. Results Eighty-three patients were eligible for long-term follow-up (21.0 ± 8.7,
mean ± standard deviation [21.5; 2.1–40.0, median; min–max] years after surgical repair).
Actual long-term mortality was 3.4%. Quality of life (QoL; self- or caregiver-reported in
patients with Down syndrome) was excellent or good in 81%, mild congestive heart failure
was present in 16%, moderate in 3.6% as estimated by New York Heart Association
classification. Echocardiography revealed normal systolic left ventricular function in all
cases. Regurgitation of the right atrioventricular valve was mild in 48%, mild–moderate in
3.6%, and moderate in 1.2%. The left atrioventricular valve was mildly stenotic in 15% and
mild to moderately stenotic in 2%; regurgitation was mild in 54%, mild to moderate in 13%,
and moderate in 15% of patients. Freedom from left atrioventricular-valve-related
reoperation was 95.3, 92.7, and 89.3% after 5, 10, and 30 years, respectively. Permanent
pacemaker therapy, as an immediate result of CAVSD repair ( n = 7) or as a result
of late-onset sick sinus syndrome ( n = 5), required up to six reoperations in
single patients. Freedom from pacemaker-related reoperation was 91.4, 84.4, and 51.5%
after 5, 10, and 30 years, respectively. Conclusion Up to 40 years after single-patch repair of CAVSD, clinical status and
functional results are promising, particularly, in terms of atrioventricular valve
function. Permanent pacemaker therapy results in a life-long need for surgical
reinterventions.
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Self-management of patients with heart valve replacement and its clinical outcomes: a systematic review. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:40-49. [PMID: 34552643 PMCID: PMC8442083 DOI: 10.5114/kitp.2021.105186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/15/2021] [Indexed: 11/17/2022]
Abstract
Introduction For patients with heart valve replacement, self-management can play an essential role in the management of their condition. Aim This review aimed to identify the aspects of self-management and its clinical outcomes in patients with heart valve replacement. Material and methods In this systematic review, the peer-reviewed research literature on self-management of patients with heart valve replacement was assessed. Since May 2020, the PubMed, Scopus, and web of science databases were searched regardless of time and language limitations. The eligibility of the articles was assessed by title or abstract according to the search strategy. Article selection was applied regarding to inclusion and exclusion criteria. Also, article screening was conducted by 2 independent authors. Results Twenty-five studies were considered in this systematic review. For inclusion, the self-management of patients had to have prerequisites, appropriate training, and be applicable in the aspects of anticoagulation therapy self-management, international normalized ratio (INR) self-testing, low-dose INR self-management, and heart valve function self-monitoring. In this method, through proper management of INR levels and anticoagulation therapy, the complications rate could be reduced and the patients would be able to diagnose functional disorders in the early stages by monitoring the valve function. This procedure was able to prevent the progression of complications. Conclusions Self-management is an applicable protocol in the field of anticoagulation therapy, INR control, low-dose INR management, and the monitoring of cardiac valve function. This protocol could improve the quality of treatment for these patients through upgrading the care standards.
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Verstraete A, Herregods MC, Verbrugghe P, Lamberigts M, Vanassche T, Meyns B, Oosterlinck W, Rega F, Adriaenssens T, Van Hoof L, Keuleers S, Vandenbriele C, Sinnaeve P, Janssens S, Dubois C, Meuris B, Verhamme P. Antithrombotic Treatment After Surgical and Transcatheter Heart Valve Repair and Replacement. Front Cardiovasc Med 2021; 8:702780. [PMID: 34422930 PMCID: PMC8375148 DOI: 10.3389/fcvm.2021.702780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
New antithrombotic drugs have been developed, new valve types have been designed and minimally invasive transcatheter techniques have emerged, making the choice of antithrombotic therapy after surgical or transcatheter heart valve repair and replacement increasingly complex. Moreover, due to a lack of large randomized controlled trials many recommendations for antithrombotic therapy are based on expert opinion, reflected by divergent recommendations in current guidelines. Therefore, decision-making in clinical practice regarding antithrombotic therapy for prosthetic heart valves is difficult, potentially resulting in sub-optimal patient treatment. This article compares the 2017 ESC/EACTS and 2020 ACC/AHA guidelines on the management of valvular heart disease and summarizes the available evidence. Finally, we established a convenient consensus on antithrombotic therapy after valve interventions based on over 800 annual cases of surgical and transcatheter heart valve repair and replacement and a multidisciplinary team discussion between the department of cardiovascular diseases and cardiac surgery of the University Hospitals Leuven, Belgium.
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Affiliation(s)
- Andreas Verstraete
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Peter Verbrugghe
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marie Lamberigts
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Oosterlinck
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Siegmund Keuleers
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Peter Sinnaeve
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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Zandi S, Imani B, Gholamreza S. Self-care training and informational support of patients with a mechanical heart valve on the international normalized ratio and bleeding complications. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2021; 18:80-86. [PMID: 34386048 PMCID: PMC8340644 DOI: 10.5114/kitp.2021.107468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/11/2021] [Indexed: 01/22/2023]
Abstract
AIM The aim of the study was to determine the effect of self-care training and informational support of patients with a mechanical heart valve on the international normalized ratio (INR) and bleeding complications. MATERIAL AND METHODS Design: A quasi-experimental study. Participants were recruited via convenience sampling and were randomly divided into two groups: control (n = 80) and intervention (n = 80). Participants in the control group received only routine training; in addition, the intervention group received 6 sessions of self-care training and 6 months of informational support. Monthly the level of INR and incidence of bleeding were determined. Data were analyzed using the independent t-test and χ2 in SPSS16 software at a significance level of 0.05. RESULTS During 6 months of follow-up, except for the third month, the frequency of INR levels in the therapeutic target range (2.5-3.5) in the intervention group was significantly higher than that in the control group (p < 0.05). Also in the intervention group, the incidence of bleeding complications was lower than that in the control group, but this difference was not statistically significant (p > 0.05). CONCLUSIONS Proper self-care training and informational support in patients with mechanical heart valve replacement have positive results. By maintaining self-care, the level of a therapeutic target range of INR can be maintained and the incidence of bleeding complications can be reduced.
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Affiliation(s)
- Shirdel Zandi
- MS Student, Department of Operating Room, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behzad Imani
- Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Safarpour Gholamreza
- Department of Heart Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Vogeler E, Dieterlen MT, Garbade J, Lehmann S, Jawad K, Borger MA, Meyer AL. Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device. Thorac Cardiovasc Surg 2020; 69:518-525. [PMID: 33260235 DOI: 10.1055/s-0040-1719153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The exact monitoring of the therapeutic-range international normalized ratio (INR) after left ventricular assist device (LVAD) implantation is an important aim to reduce the risk of thrombosis or bleeding complications. Service providers offer a telemedical anticoagulation service (CS). METHODS We compared LVAD patients using the CS (n = 15) to those who received regular medical care (RMC; n = 15) to investigate if telemedicine supervision increased the INR-specific time in the therapeutic range (TTR) during anticoagulation. All patients received self-management training for phenprocoumon medication according to their INR value. INR values were documented for 12 months. A survey (scale: 1 = not satisfied and 10 = very satisfied) was used to determine patient's satisfaction and psychological well-being. RESULTS A total of 1,798 INR measurements were analyzed. The TTRRosendaal was higher in patients undergoing RMC (78.1 ± 14.3%) compared with that in patients using the CS (58.3 ± 28.0%, p = 0.03). The patient's satisfaction with the coagulation setting at the beginning of the study (RMC: 6.7 ± 3.1, CS: 7.2 ± 3.0, p = 0.74) and psychological wellbeing (RMC: 6.5 ± 1.9, CS: 6.5 ± 2.7, p = 0.97) were comparable between both groups. CONCLUSION We found that INR self-management is superior regarding the efficiency of post-LVAD anticoagulation therapy when compared with telemedical (CS)-based INR management in a small study cohort. Intensive training by experienced staff was able to replace CS.
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Affiliation(s)
- Elisa Vogeler
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | | | - Jens Garbade
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Sven Lehmann
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Khalil Jawad
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Michael A Borger
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Anna L Meyer
- Department of Cardiac Surgery, University Hospital, Heidelberg, Germany
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Corrochano M, Jiménez B, Millón J, Gich I, Rambla M, Gil E, Caparrós P, Macho R, Souto JC. Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: clinical outcomes in a single centre cohort after long-term follow-up. BMC Cardiovasc Disord 2020; 20:166. [PMID: 32276619 PMCID: PMC7146979 DOI: 10.1186/s12872-020-01448-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background Patient self-management (PSM) of vitamin K antagonists (VKA) seems a very promising model of care for oral anticoagulation in terms of efficacy and safety. In comparison with other management models of VKA therapy, the number of scientific publications supporting the advantages of PSM is more limited. Currently, most of the scarce information comes from randomized clinical trials. Moreover, a small number of studies have assessed PSM of VKA therapy in real life conditions. Methods We analyzed clinical outcomes of 927 patients in a single center (6018.6 patient-years of follow-up). Recruitment took place between 2002 and 2017. All patients followed a structured training program, conducted by specialized nurses. Results Fifty percent of individuals had a mechanical heart valve (MHV), 23% suffered from recurrent venous thromboembolism (VTE) or high-risk thrombophilia, and 13% received VKA therapy because of atrial fibrillation (AF). Median follow-up was 6.5 years (range 0.1–15.97 years), median age was 58.1 years (IQR 48–65.9) and 46.5% were women. The incidence of major complications (either hemorrhagic or thromboembolic) was 1.87% patient-years (pt-ys) with a 95% CI of 1.54–2.27. The incidence of major thromboembolic events was 0.86% pt-ys (95% CI 0.64–1.13) and that of major hemorrhagic events was 1.01% pt-ys (95% CI 0.77–1.31). The incidence of intracranial bleeding was 0.22% pt-ys (95% CI 0.12–0.38). In terms of clinical indication for VKA therapy, the incidence of total major complications was 2.4% pt-ys, 2.0% pt-ys, 0.9% pt-ys and 1.34% pt-ys for MHV, AF, VTE and other (including valvulopathies and myocardiopathies), respectively. Clinical outcomes were worse in patients with multiple comorbidities, previous major complications during conventional VKA therapy, and in older individuals. The percentage of time in therapeutic range (TTR) was available in 861 (93%) patients. Overall, the mean (SD) of TTR was 63.6 ± 13.4%, being higher in men (66.2 ± 13.1%) than women (60.6 ± 13.2%), p < 0.05. Conclusions In terms of clinically relevant outcomes (incidence of major complications and mortality), PSM in real life setting seems to be a very good alternative in properly trained patients.
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Affiliation(s)
- M Corrochano
- Haemostasis and Thrombosis Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - B Jiménez
- Institut de Recerca. Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - J Millón
- Haemostasis and Thrombosis Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I Gich
- Clinical Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Rambla
- Haemostasis and Thrombosis Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Gil
- Haemostasis and Thrombosis Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - P Caparrós
- Haemostasis and Thrombosis Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Macho
- Haemostasis and Thrombosis Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J C Souto
- Haemostasis and Thrombosis Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Res LCS, Lubberts B, Shah SH, DiGiovanni CW. Health-related quality of life after adverse bleeding events associated with antithrombotic drug therapy - A systematic review. Hellenic J Cardiol 2018; 60:3-10. [PMID: 29908761 DOI: 10.1016/j.hjc.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 12/29/2022] Open
Abstract
Little is known about the health-related quality of life (HRQOL) following adverse bleeding events associated with antithrombotic drug therapy. This systematic review assesses the HRQOL of patients who suffered a bleeding event related to antithrombotic drug use. A literature search was performed using PubMed, EMBASE, and the Cochrane Library from inception through June 16, 2017. Studies measuring HRQOL after a bleeding event related to antithrombotic drug therapy for primary or secondary prevention of a thromboembolic event were included. Four studies with a total of 13,209 patients met the inclusion criteria, and of them, 3,649 patients developed a bleeding event. Patients who were included received antithrombotic drugs because of acute myocardial infarction or atrial fibrillation. EQ-5D, SF-36, and GHP MOS-13 were used to measure HRQOL. The follow-up time ranged from 6 to 29 months. Patients who suffered a bleeding event reported worse HRQOL compared to those who did not (EQ-5D - average increase on all domains of 0.09, p-values ranging from <0.001 to 0.003; SF-36 - average decrease on all domains of 21.4, p < 0.001; and GHP MOS-13 score - decrease of 11.9 points, p < 0.05) and an increased health concern (13.4-point increase; p < 0.05). In conclusion, adverse bleeding events occurring because of the use of antithrombotic agents are associated with a clinically relevant lower HRQOL and hence deserve more attention as part of the shared decision-making process between patients and providers. These data should be valuable for facilitating more substantive care and risk discussions regarding potential changes in outcome and rehabilitation.
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Affiliation(s)
- Lodewijk C S Res
- Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Bart Lubberts
- Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Shivesh H Shah
- Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Christopher W DiGiovanni
- Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Orale Antikoagulation mit Vitamin K-Antagonisten – ein Update. Wien Med Wochenschr 2017; 168:121-132. [DOI: 10.1007/s10354-017-0577-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
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Christensen TD, Skjøth F, Nielsen PB, Maegaard M, Grove EL, Larsen TB. Self-Management of Anticoagulant Therapy in Mechanical Heart Valve Patients: A Matched Cohort Study. Ann Thorac Surg 2015; 101:1494-9. [PMID: 26572254 DOI: 10.1016/j.athoracsur.2015.09.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/19/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient-self-management (PSM) of oral anticoagulant therapy with vitamin K antagonists for mechanical heart valves has demonstrated efficacy in randomized controlled trials. However, the effectiveness of PSM in clinical practice has only been investigated in small trials. Our aim was to evaluate the effectiveness of PSM of oral anticoagulant therapy in mechanical heart valve patients. METHODS We conducted a matched cohort study: cases were patients with a mechanical heart valve performing PSM affiliated with Aarhus University Hospital or Aalborg University Hospital, Denmark, in the period 1996 to 2012 (n = 615). Prospectively registered patient data were obtained from databases at two hospitals, and cross linkage between these databases and national patient registries provided detailed information on comorbidities and events. Control patients were matched (on sex, date of birth, year of first valve surgery, and grouped valve position) in a ratio of 5:1 (n = 3,075) with patients receiving conventional management who were randomly selected within the match group. The effectiveness and safety was estimated using major bleeding and thromboembolic events and death as outcomes. RESULTS We observed low event rates in the PSM group. After 5 years, PSM was associated with a lower risk of all-cause mortality compared with conventional management (adjusted hazard ratio of 0.49, 95% confidence interval: 0.34 to 0.71). The hazard ratios for thromboembolism and major bleeding were 0.91 (95% confidence interval: 0.66 to 1.24) and 0.83 (95% confidence interval: 0.56 to 1.22). CONCLUSIONS Owing to superior clinical effectiveness, self-managed oral anticoagulant therapy may potentially improve the standard of care for patients with mechanical heart valves.
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Affiliation(s)
- Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Brønnum Nielsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Maegaard
- Department of Cardiothoracic and Vascular Surgery and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Torben Bjerregaard Larsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, AF Study Group, Aalborg University Hospital, Aalborg, Denmark
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Arjunon S, Ardana PH, Saikrishnan N, Madhani S, Foster B, Glezer A, Yoganathan AP. Design of a pulsatile flow facility to evaluate thrombogenic potential of implantable cardiac devices. J Biomech Eng 2015; 137:045001. [PMID: 25587891 DOI: 10.1115/1.4029579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Indexed: 11/08/2022]
Abstract
Due to expensive nature of clinical trials, implantable cardiac devices should first be extensively characterized in vitro. Prosthetic heart valves (PHVs), an important class of these devices, have been shown to be associated with thromboembolic complications. Although various in vitro systems have been designed to quantify blood-cell damage and platelet activation caused by nonphysiological hemodynamic shear stresses in these PHVs, very few systems attempt to characterize both blood damage and fluid dynamics aspects of PHVs in the same test system. Various numerical modeling methodologies are also evolving to simulate the structural mechanics, fluid mechanics, and blood damage aspects of these devices. This article presents a completely hemocompatible small-volume test-platform that can be used for thrombogenicity studies and experimental fluid mechanics characterization. Using a programmable piston pump to drive freshly drawn human blood inside a cylindrical column, the presented system can simulate various physiological and pathophysiological conditions in testing PHVs. The system includes a modular device-mounting chamber, and in this presented case, a 23 mm St. Jude Medical (SJM) Regents® mechanical heart valve (MHV) in aortic position was used as the test device. The system was validated for its capability to quantify blood damage by measuring blood damage induced by the tester itself (using freshly drawn whole human blood). Blood damage levels were ascertained through clinically relevant assays on human blood while fluid dynamics were characterized using time-resolved particle image velocimetry (PIV) using a blood-mimicking fluid. Blood damage induced by the tester itself, assessed through Thrombin-anti-Thrombin (TAT), Prothrombin factor 1.2 (PF1.2), and hemolysis (Drabkins assay), was within clinically accepted levels. The hydrodynamic performance of the tester showed consistent, repeatable physiological pressure and flow conditions. In addition, the system contains proximity sensors to accurately capture leaflet motion during the entire cardiac cycle. The PIV results showed skewing of the leakage jet, caused by the asymmetric closing of the two leaflets. All these results are critical to characterizing the blood damage and fluid dynamics characteristics of the SJM Regents® MHV, proving the utility of this tester as a precise system for assessing the hemodynamics and thrombogenicity for various PHVs.
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12
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Jeon HR, Park JS. Development and Application of a Self-management Program based on Prothrombin INR Monitoring for Patients with Cardiac Valve Replacement. J Korean Acad Nurs 2015; 45:554-64. [DOI: 10.4040/jkan.2015.45.4.554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/06/2015] [Accepted: 05/08/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Hyun Rye Jeon
- Dongsan Medical Center, Keimyung University, Daegu, Korea
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13
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Nilsson H, Grove EL, Larsen TB, Nielsen PB, Skjøth F, Maegaard M, Christensen TD. Sex differences in treatment quality of self-managed oral anticoagulant therapy: 6,900 patient-years of follow-up. PLoS One 2014; 9:e113627. [PMID: 25415603 PMCID: PMC4240606 DOI: 10.1371/journal.pone.0113627] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/27/2014] [Indexed: 11/18/2022] Open
Abstract
Background Patient-self-management (PSM) of oral anticoagulant therapy with vitamin K antagonists has demonstrated efficacy in randomized, controlled trials. However, the effectiveness and efficacy of PSM in clinical practice and whether outcomes are different for females and males has been sparsely investigated.The objective is to evaluate the sex-dependent effectiveness of PSM of oral anticoagulant therapy in everyday clinical practice. Methods All patients performing PSM affiliated to Aarhus University Hospital and Aalborg University Hospital, Denmark in the period 1996–2012 were included in a case-series study. The effectiveness was estimated using the following parameters: stroke, systemic embolism, major bleeding, intracranial bleeding, gastrointestinal bleeding, death and time spent in the therapeutic international normalized ratio (INR) target range. Prospectively registered patient data were obtained from two databases in the two hospitals. Cross-linkage between the databases and national registries provided detailed information on the incidence of death, bleeding and thromboembolism on an individual level. Results A total of 2068 patients were included, representing 6,900 patient-years in total. Males achieved a significantly better therapeutic INR control than females; females spent 71.1% of the time within therapeutic INR target range, whereas males spent 76.4% (p<0.0001). Importantly, death, bleeding and thromboembolism were not significantly different between females and males. Conclusions Among patients treated with self-managed oral anticoagulant therapy, males achieve a higher effectiveness than females in terms of time spent in therapeutic INR range, but the incidence of major complications is low and similar in both sexes.
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Affiliation(s)
- Hanna Nilsson
- Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Torben Bjerregaard Larsen
- Department of Cardiology, Centre for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Brønnum Nielsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Maegaard
- Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
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Long-term absolute and relative survival after aortic valve replacement: a prospective cohort study. Eur J Anaesthesiol 2014; 30:695-703. [PMID: 24047727 DOI: 10.1097/eja.0b013e3283657829] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aortic valve replacement is one of the most common cardiac surgical procedures, especially in elderly patients. Whether or not there is a net life gain over a long period of time is a matter for debate. OBJECTIVE To compare survival of patients with that of the age, sex, and follow-up year-matched normal population (relative survival). DESIGN Single-centre, prospectively collected data. SETTING Tertiary care centre, Vienna, Austria. PATIENTS We enrolled 1848 patients undergoing elective aortic valve replacement between 1997 and the end of 2008. INTERVENTIONS None. MAIN OUTCOME MEASUREMENT Relative survival at the end of 2011 as determined by relative Cox regression analysis. RESULTS Sixty-nine patients (3.7%) died within the first 30 days. Another 70 patients (3.8%) died within the first year and 429 (23.2%) died during the remaining follow-up period. The longest follow-up period was 14 years (median, 5.8; interquartile range, 3.2 to 8.9). Medical risk indicators for relative survival were diabetes mellitus [hazard ratio 1.69, 95% confidence interval, CI 1.37 to 2.07, P<0.001], pulmonary disease (hazard ratio 1.45, 95% CI 1.16 to 1.81, P=0.001), history of atrial fibrillation (hazard ratio 1.35, 95% CI 1.10 to 1.66, P=.005) and angiotensin-converting enzyme inhibitor medication (hazard ratio 1.21, 95% CI 1.02 to 1.44, P=0.031). Perioperative risk indicators were urgent surgery (hazard ratio 1.40, 95% CI 1.00 to 1.94, P=0.047), resternotomy at 48 h or less (hazard ratio 1.87, 95% CI 1.29 to 2.70, P=0.001), resternotomy at more than 48 h (hazard ratio 1.80, 95% CI 1.32 to 2.45, P<0.001), blood transfusion (hazard ratio 1.06, 95% CI 1.01 to 1.12, P=0.018) and renal replacement therapy (hazard ratio 2.02, 95% CI 1.41 to 2.90, P<0.001). Relative survival was highest in the oldest age quartile (76 to 94 years) and lowest in the youngest (19 to 58 years) (hazard ratio 0.27, 95% CI 0.21 to 0.36; P<0.001). CONCLUSION Patients who survived the first year after aortic valve replacement had a similar chance of survival as the matched normal population. Relative survival benefit was higher in the oldest age quartile.
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Nagler M, Bachmann LM, Schmid P, Raddatz Müller P, Wuillemin WA. Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study. PLoS One 2014; 9:e95761. [PMID: 24748062 PMCID: PMC3991723 DOI: 10.1371/journal.pone.0095761] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/30/2014] [Indexed: 12/20/2022] Open
Abstract
Patient self-management (PSM) of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years) were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2-12.8 years). Median age at the time of training was 54.2 years (range 18.2-85.2) and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1-1.7) with a higher rate in patients with atrial fibrillation (2.5; 1.6-3.7; p<0.001), patients>50 years of age (2.0; 1.6-2.6; p<0.001), and men (1.6; 1.2-2.1; p = 0.036). The rate of thromboembolic events was 0.4 (0.2-0.6) and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9-1.5) per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.
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Affiliation(s)
- Michael Nagler
- Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, and Department of Haematology and Central Haematology Laboratory, Inselspital University Hospital, Berne, Switzerland
| | | | - Pirmin Schmid
- Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Pascale Raddatz Müller
- Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Walter A. Wuillemin
- Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, 6000 Lucerne, and University of Berne, Berne, Switzerland
- * E-mail:
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