Linda J Thomson Mangnall1, David W Sibbritt2, Nihaya Al-Sheyab3, Robyn D Gallagher4. 1. Cardiothoracic Medical and Surgical Telemetry Unit, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia; Faculty of Nursing and Midwifery, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia. 2. Faculty of Health , University of Technology , Sydney, New South Wales , Australia. 3. Faculty of Nursing and Midwifery, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan. 4. Charles Perkins Centre and Sydney Nursing School, University of Sydney , Camperdown, New South Wales , Australia.
Abstract
OBJECTIVES: Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings. This study sought to identify predictors of warfarin adherence after valve replacement surgery for RHD in Fiji (n=127). METHODS: A cross-sectional study design was used. RESULTS: The sample had a mean age of 31.23 years (SD 13.34) and a mean time-since-surgery of 3.72 years (SD 3.95). Just over half were women (n=71, 56%) and almost two-thirds were indigenous (I-taukei, n=78, 61%). Most had an isolated valve procedure (n=94, 74%) and at the time of survey, they were in New York Heart Association Class I (n=97, 76%). A quarter (n=33, 26%) reported poor adherence with anticoagulation therapy and 13.38% (n=17) reported complete warfarin cessation. While younger age was significantly associated with non-adherence to warfarin therapy (p=0.008), the independent predictors of people who discontinue warfarin completely were those not understanding why warfarin was needed (OR=9.97, p=0.006); a history of forgetting to take warfarin (OR=8.64, p=0.0013) and travel time to heart clinic >1 hour (OR=5.80, p=0.039). CONCLUSIONS: While medication adherence is complex and multifactorial, the consequences of warfarin non-adherence are potentially catastrophic. These results provide an important first step towards the development of country-specific and disease-specific strategies to improve warfarin adherence.
OBJECTIVES: Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings. This study sought to identify predictors of warfarin adherence after valve replacement surgery for RHD in Fiji (n=127). METHODS: A cross-sectional study design was used. RESULTS: The sample had a mean age of 31.23 years (SD 13.34) and a mean time-since-surgery of 3.72 years (SD 3.95). Just over half were women (n=71, 56%) and almost two-thirds were indigenous (I-taukei, n=78, 61%). Most had an isolated valve procedure (n=94, 74%) and at the time of survey, they were in New York Heart Association Class I (n=97, 76%). A quarter (n=33, 26%) reported poor adherence with anticoagulation therapy and 13.38% (n=17) reported complete warfarin cessation. While younger age was significantly associated with non-adherence to warfarin therapy (p=0.008), the independent predictors of people who discontinue warfarin completely were those not understanding why warfarin was needed (OR=9.97, p=0.006); a history of forgetting to take warfarin (OR=8.64, p=0.0013) and travel time to heart clinic >1 hour (OR=5.80, p=0.039). CONCLUSIONS: While medication adherence is complex and multifactorial, the consequences of warfarin non-adherence are potentially catastrophic. These results provide an important first step towards the development of country-specific and disease-specific strategies to improve warfarin adherence.
Authors: Eric G Butchart; Nicola Payne; Hui-Hua Li; Keith Buchan; Kayapanda Mandana; Gary L Grunkemeier Journal: J Thorac Cardiovasc Surg Date: 2002-04 Impact factor: 5.209
Authors: Amy D Waterman; Paul E Milligan; Laura Bayer; Gerald A Banet; Susan K Gatchel; Brian F Gage Journal: Am J Health Syst Pharm Date: 2004-06-15 Impact factor: 2.637
Authors: Alec B Platt; A Russell Localio; Colleen M Brensinger; Dean G Cruess; Jason D Christie; Robert Gross; Catherine S Parker; Maureen Price; Joshua P Metlay; Abigail Cohen; Craig W Newcomb; Brian L Strom; Mitchell S Laskin; Stephen E Kimmel Journal: Pharmacoepidemiol Drug Saf Date: 2008-09 Impact factor: 2.890
Authors: Kjersti Oterhals; Christi Deaton; Sabina De Geest; Tiny Jaarsma; Mattie Lenzen; Philip Moons; Jan Mårtensson; Karen Smith; Simon Stewart; Anna Strömberg; David R Thompson; Tone M Norekvål Journal: Eur J Cardiovasc Nurs Date: 2013-05-27 Impact factor: 3.908
Authors: Nicoletta Riva; Christian Borg Xuereb; Michael Makris; Walter Ageno; Alex Gatt Journal: Patient Prefer Adherence Date: 2019-06-19 Impact factor: 2.711