| Objective1To explore whether it is feasible that group visits was applied to patients whotake warfarin for anticoagulant therapy after mechanical heart valve replacement;2To observe the degree of cognition, anticoagulant treatment compliance, thepercentage of INR in range, complication and quality of life in patients urdergoingmechanical heart valve replacement managed by group visits.Methods1A convenience sampling of88subjects were collected from January,2013toJune,2013. They were successfully replaced mechanical heart valve in our hospitalcardiovascular surgery.2According to the parity of health education month and flip a coin method,patients were randomly divided into2group，1,3,5month set as intervention grouppatients, patients with2,4,6month set as control group.the control group wasfollowed with routine management: the day before discharging from hospital, thepatients and their caregivers had health education and one-on-one conversation,learned the knowledge of oral warfarin anticoagulant medicine principle, purpose,time, attention, etc. Give the patients warfarin anticoagulation therapy handbook after mechanical valve replacement befor discharged from hospital.The patients shouldmonitor INR values regularly and have outpatient follow-up after discharged. Thetreatment group was management with group visits, every afternoon in the Mondayand Wednesday, last1h, patients took part in the group visits, the content of groupvisits including: warming up communication for5minutes, anticoagulation educationof warfarin for35minutes; answering participants’ questions for10minutes;summary for10minutes. The management was the same with control group afterdischarged.3Designed general situation questionnaire to record the patient’s generalinformation and disease information, the cranial content validity and Cornbach’salpha scores of warfarin anticoagulation cognitive questionnaire and warfarinanticoagulation compliance questionnaire were0.83,0.81and0.89,0.81respectively.The warfarin anticoagulation record scale, recorded the date of patient monitoringINR values, INR values, and warfarin dose etc.36-Item Short Form Health surveytool developed to assess the quality of life of patients with oral warfarin.4The patients should fill the questionnaire face to face or telephone at6monthsafter discharged, The follow-up was closed on June30,2013.Results1According to the patient’s general and disease information, patients’ averageage was46.18±8.197years old, junior high school degree and the followingaccounted for about78%, living in the rural area accounted for about71%, mitralvalve replacement were44.2%.1～2kinds of co-morbidities patients were62.6%,noco-morbidities disease patients were34.9%.2The quality of life score of patients before intervention was89.80±14.12,Physieal Functioning(PF) score was56.44±20.11, Role Physieal (RP) score was60.12±24.19, Bodily Pain(BP) score was71.18±23.05, Mental Health(MH) scorewas55.91±19.03,Vitality(VT) score was51.36±21.59, Social Funetioning(SF)score was59.09±24.37,Role Emotional(RE) score was58.17±22.36,General Health(GH) score was52.54±18.15.3The first two items of warfarin cognition of patients were,how to takewarfarin and what is the time;the last two were the mechanism of mechanical valves leading to cardiac thrombosis, self-examination tendency of embolism symptoms, thecognitive degree of treatment group were better than the control group.4At6months postoperatively, the quality of life scores of treatment group andcontrol group were103.31±15.16,15.16±103.31respectively, the quality of life oftreatment group is higher compared with control group except Vitality and BodilyPain, the difference was statistically significant, and the quality of life of treatmentgroup and control group were both improved compared with before.5In the three dimensions of anticoagulation compliance, INR monitoringcompliance and the adherence to life-style in patients, treatment group score werehigher than the control group.6At6months postoperatively, the percentage of INRs in range of the treatmentgroup and control group patients were70.9%,63.3%respectively, treatment group ishigher than the control group.7At6months postoperatively, the complications in treatment group were5(11.6%), bleeding were5(11.6%), no embolism; the complications in the controlgroup were9(20.9%), bleeding were8(18.6%), thrombosis were1(2.3%).complications of treatment group was lower than the control group, but there was nostatistically significant difference.Conclusions1compared with the conventional management mode, group visits can enhancethe warfarin anticoagulation therapy compliance and the warfarin anticoagulationcognition of patients after mechanical valve replacement.2group visits can improve quality of life related oral warfarin of patientsundergoing the mechanical valve replacement, all dimensions of quality of life haveincreased.3group visits can improve the percentage of INRs in range and reduce thecomplications related warfarin of patients after mechanical valve replacement. |
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