Xia Yuan1, Yihong Chen2, Yu Zhuang3, Wei Qin2, Ying Lin2. 1. Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China; School of Nursing,Fudan university, Shanghai, China. 2. Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China. 3. School of Nursing,Fudan university, Shanghai, China.
Abstract
BACKGROUND: Valvular heart disease (VHD) is a leading cause of heart diseases and death, and heart valve replacement (HVR) plays a fundamental role in treating valve disease and improving the function of valves. The lack of continuity of care (CC, also known as transitional care) for postoperative patients after discharge often results in a variety of complications, bringing severe pain to the patients and diminishing their quality of life. METHODS: We systematically searched for relevant randomized controlled trials (RCTs) in Cochrane databases, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chongqing VIP, and Wanfang Data. The methodological quality of the included articles was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. The meta-analysis was conducted with RevMan 5.2 software. RESULTS: A total of 14 RCTs (involving 1,825 patients), all in Chinese language, were included in the analysis, including 920 patients in the CC group and 905 patients in the control group (receiving the routine care). Meta-analysis showed that, compared with the control group, the CC group had significantly higher anticoagulation therapy adherence [RR =1.36, 95% CI: (1.25,1.48), P<0.00001], higher awareness of anticoagulation [RR =1.14, 95% CI: (1.09, 1.18), P<0.0001], and lower incidences of anticoagulation complications and adverse events [RR =0.24, 95% CI: (0.17, 0.35), P<0.00001]. In addition, the 5 domains reflecting quality of life including physical domain [MD =2.38, 95% CI: (1.30, 3.46), P<0.0001], psychological domain [MD =2.92, 95% CI: (1.47, 4.37), P<0.0001], levels of independence [MD =4.03, 95% CI: (1.04, 7.01), P=0.008], social relationships [MD=2.56, 95% CI: (1.81, 3.32), P<0.00001], and environment [MD =4.15, 95% CI: (1.16,7.14), P=0.007] were also significantly improved. DISCUSSION: Our results showed CC can effectively improve patients' anticoagulation therapy adherence and raise their awareness about medications, reduce the incidences of complications and adverse events, and thus improve the patients' quality of life. However, only a limited number of high-quality RCTs were included in our current analysis, and studies with more rigorous designs are warranted to further validate the impacts of CC on anticoagulation therapy adherence and quality of life after HVR.
BACKGROUND:Valvular heart disease (VHD) is a leading cause of heart diseases and death, and heart valve replacement (HVR) plays a fundamental role in treating valve disease and improving the function of valves. The lack of continuity of care (CC, also known as transitional care) for postoperative patients after discharge often results in a variety of complications, bringing severe pain to the patients and diminishing their quality of life. METHODS: We systematically searched for relevant randomized controlled trials (RCTs) in Cochrane databases, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chongqing VIP, and Wanfang Data. The methodological quality of the included articles was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. The meta-analysis was conducted with RevMan 5.2 software. RESULTS: A total of 14 RCTs (involving 1,825 patients), all in Chinese language, were included in the analysis, including 920 patients in the CC group and 905 patients in the control group (receiving the routine care). Meta-analysis showed that, compared with the control group, the CC group had significantly higher anticoagulation therapy adherence [RR =1.36, 95% CI: (1.25,1.48), P<0.00001], higher awareness of anticoagulation [RR =1.14, 95% CI: (1.09, 1.18), P<0.0001], and lower incidences of anticoagulation complications and adverse events [RR =0.24, 95% CI: (0.17, 0.35), P<0.00001]. In addition, the 5 domains reflecting quality of life including physical domain [MD =2.38, 95% CI: (1.30, 3.46), P<0.0001], psychological domain [MD =2.92, 95% CI: (1.47, 4.37), P<0.0001], levels of independence [MD =4.03, 95% CI: (1.04, 7.01), P=0.008], social relationships [MD=2.56, 95% CI: (1.81, 3.32), P<0.00001], and environment [MD =4.15, 95% CI: (1.16,7.14), P=0.007] were also significantly improved. DISCUSSION: Our results showed CC can effectively improve patients' anticoagulation therapy adherence and raise their awareness about medications, reduce the incidences of complications and adverse events, and thus improve the patients' quality of life. However, only a limited number of high-quality RCTs were included in our current analysis, and studies with more rigorous designs are warranted to further validate the impacts of CC on anticoagulation therapy adherence and quality of life after HVR.
Entities:
Keywords:
Continuity of care; anticoagulant therapy; meta-analysis; quality of life