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Effectiveness of Structured Patient Education Programme on Knowledge Regarding Anticoagulation and INR Control among Patients Undergoing Mechanical Valve Replacement at AIIMS

Harmanjot Dhindsa, Ankita Sharma, Neeraj Parakh, Devagourou V, Gopichandran L

Background: Valvular heart diseases (VHD) are significant cause of mortality and morbidity globally with rheumatic heart disease (RHD) contributing to major burden in India. Management of progressive VHD requires mechanical or bioprosthetic valve replacement. Mechanical valve replacement requires lifelong anticoagulation which carries the risk of serious bleeding and thromboembolic events unless INR is maintained within the prescribed narrow therapeutic range. Effectively managing the determinants of INR control like patient education, drug- adherence, lifestyle habits, drug and food interactions and frequency of INR monitoring can help improve patient outcome.

Aim: To assess the effect of structured patient education programme on knowledge regarding anticoagulation therapy and INR Control among patients undergoing mechanical valve replacement.

Materials and methods: This quasi-experimental study was conducted among 60 admitted adult patients undergoing valve replacement surgery. Structured patient education programme was provided to the experimental group whereas control group had routine care. The baseline knowledge of both groups was assessed using a self-structured questionnaire preoperatively and post-intervention knowledge was assessed at 1-month follow-up. INR values of the patients were recorded at 7 days and 1-month follow-up.

Results: Majority of the patients in both groups (87 versus 83.3%) had poor knowledge regarding anticoagulation therapy at baseline. Median knowledge score of patients improved significantly (p<0.05). The proportion of patients within therapeutic range of INR in the experimental group was higher (23.3%) at 1-month follow-up as compared to 13.7% in the control group which was statistically not significant (p-0.59). Higher knowledge score was associated with higher monthly income and urban residence.

Conclusion: Structured patient education programme significantly improved the knowledge of patients regarding anticoagulation but had no significant effect on INR control. Patient education programme should be implemented in hospital settings in order to improve patient outcome. Keywords: structured patient education programme, anticoagulation knowledge, INR Control, mechanical heart valve replacement.