Dynamics of adherence to treatment and quality of life in patients with prosthetic heart valves who participated in the educational programs (10-year follow-up)

Abstract

Highlights. Patient education program developed for patients with prosthetic heart valves, which includes information on the anticoagulant therapy, prevention of prosthetic valve endocarditis, and physical and psychological rehabilitation, helps to improve adherence to treatment and quality of life immediately upon completion of training (6 months). The quality of life and adherence to treatment were higher at 10-year follow-up in patients undergoing full course of training, in inpatient and outpatient settings, compared with patients undergoing training in inpatient setting only.Aim. To evaluate the efficacy of the training program for patients with prosthetic heart valves in improving treatment adherence and quality of life at 10-year follow-up.Methods. Patient education program entitled “School for patients with prosthetic heart valves” was developed and implemented at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo) in 2010. The program provides knowledge and training regarding anticoagulant therapy, prevention of prosthetic valve endocarditis, physical and psychological rehabilitation. The training group consisted of 92 patients who completed a full course of training (6 months). The control group included 56 patients who completed training in inpatient setting only. Long-term efficacy of the developed education program was assessed at 10-year follow-up via evaluation of the indicators of adherence to treatment (questionnaire for determining the integral indicator of adherence to treatment (IIAT)) and the quality of life (using Short-Form 36-item questionnaire (SF-36)).Results. Initially, data analysis showed no statistically significant differences between the groups in the quality of life and adherence to treatment. Six months later the IIAT score in the training group (full course of training) was 9.15±1.16, in controls the score was 6.20±1.05 (р = 0.0001). Highest IIAT scores in the training group remained similar (8.10±1.20 points) at 10-year follow-up, in the control group it was lower - 5.19±1.09 (р = 0.0001). After 6 months, physical component summary score increased by 24% over baseline in controls (р = 0.0001) and by 25% in the training group (р = 0.0001). After 6-month follow-up, there was an improvement in the psychological component summary score by 14.5% (р = 0.0001) in the control group and by 42.8% in the training group (р = 0.0001). 10 years after completion of training, physical component and mental component summary scores were higher in patients undergoing full training course - 8.3% (р = 0.0001) and 14.3% (р = 0.0001), respectively.Conclusion. Patient education program “School for patients with prosthetic heart valves” via full course of training increases levels of adherence to treatment and quality of life mainly due to improvement of psychological component summary score in the early period (6 months) and at 10-year follow-up.