A Study On The Self-management Status And Influencing Factors Of Patients With Mechanical Heart Valve Replacement In Rural Areas

Mechanical heart valve replacement(MHVR)is the most common method for the treatment of cardiac valvular disease currently.Patients need a lifetime therapy of oral warfarin anticoagulation.Affected by a variety of factors,this therapy will easily result in many anticoagulant complications.Relevant studies have indicated that patients' good self-management ability plays a crucial role in reducing anticoagulant complications and improving the quality of life.The self-management ability of patients has local regional characteristics,at present,there are few reports on the self-management of patients with MHVR in rural areas,and the level of self-management is not clear.Therefore,this study investigated the status of self-management of patients with MHVR in rural areas of Nanchong,Sichuan Province,and analyzed the relevant influencing factors,so as to provide reference for regional anticoagulation management in the future.Objectives:To investigate the status of self-management of patients with MHVR in rural areas of Nanchong,Sichuan province;to analyze the factors affecting the level of self-management of patients in rural areas;to explore the relationship between the main influencing factors and the self-management behavior of patients with MHVR in rural areas;to provide reference for the future regional anticoagulation management.Methods:Patients in rural areas of Nanchong city who underwent MHVR surgery in the Affiliated Hospital of North Sichuan Medical College from January 2011 to December 2018 were selected as the research subjects.Patients who met the inclusion criteria were investigated by outpatient follow-up and telephone follow-up.Warfarin Anticoagulation Knowledge Questionnaire,Perceived Social Support Scale(PSSS)and Patient Self-management Scale were adopted to evaluate the self-management status of patients with MHVR.Statistical software of Statistical Product and Service Solutions(SPSS Version 22.0)was used to analyze the data.Results:1.The mean score of warfarin anticoagulation knowledge level of 571 patients with MHVR in rural areas was 7.32±2.86;the score index was 43.75%and 77.93%of the patients had poor knowledge of warfarin anticoagulation.2.The scores of the perceived social support scale:the mean scores of in-family support and was out-of-family support were 20.96±3.05,38.09±6.95,respectively and the general mean score was 59.05±7.99.3.The total score of patients'self-management was 85.26±14.79;13.84%of the patients displayed high self-management level,and 86.16%of them had moderate self-management ability or below.The scoring rate of each dimension was between 50.88%and 80.93%.The scoring rates of the six dimensions of patient' self-management,from high to low,were treatment compliance management,daily life management,emotion management,self-efficacy management,symptom management and information management.4.The results of single factor analysis showed that the main factors affecting patients' self-management were age,gender,educational level,annual income per capita,marital status,postoperative time,residence and distance from the regional central hospital,one-way time and cost spent on trip to the hospital for medical treatment(P<0.05).5.The results of Pearson correlation analysis showed that the level of anticoagulation therapy knowledge,scores of perceived social support and self-management were positively correlated(r values were 0.19 and 0.36,respectively).6.The results of multi-factor analysis showed that the middle-aged patients,women,families with annual income per capita over 30000 yuan,the distance between residence and regional central hospital of less than 50 kilometers,within 1 year after surgery,and those with a high level of anticoagulation knowledge and understanding of social support had the highest self-management ability(P<0.05).Conclusions:1.The level of self-management of patients with MHVR in rural areas,especially the ability of symptom management and information management,is generally low.2.The patients'overall level of warfarin anticoagulation knowledge and understanding of social support is generally low in the surveyed areas.3.Importance should be attached to the self-management ability of the elderly,male patients,patients with low educational level,low family income,poor knowledge level of warfarin anticoagulation therapy and low level of social support,those living far from the regional central hospital.