Predictors of warfarin non-adherence in younger adults after valve replacement surgery in the South Pacific

Mangnall, LJT; Sibbritt, DW; Al-Sheyab, N; Gallagher, RD

Predictors of warfarin non-adherence in younger adults after valve replacement surgery in the South Pacific

Mangnall, LJT Sibbritt, DW

Al-Sheyab, N Gallagher, RD

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Publication Type:: Journal Article
Citation:: Heart Asia, 2016, 8 (2)
Issue Date:: 2016-06-01

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Field	Value	Language
dc.contributor.author	Mangnall, LJT	en_US
dc.contributor.author	Sibbritt, DW https://orcid.org/0000-0003-3561-9447	en_US
dc.contributor.author	Al-Sheyab, N	en_US
dc.contributor.author	Gallagher, RD https://orcid.org/0000-0001-5588-9351	en_US
dc.date.available	2016-05-17	en_US
dc.date.issued	2016-06-01	en_US
dc.identifier.citation	Heart Asia, 2016, 8 (2)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/117196
dc.description.abstract	Objectives Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings. This study sought to identify predictors of warfarin adherence after valve replacement surgery for RHD in Fiji (n=127). Methods A cross-sectional study design was used. Results The sample had a mean age of 31.23 years (SD 13.34) and a mean time-since-surgery of 3.72 years (SD 3.95). Just over half were women (n=71, 56%) and almost two-thirds were indigenous (I-taukei, n=78, 61%). Most had an isolated valve procedure (n=94, 74%) and at the time of survey, they were in New York Heart Association Class I (n=97, 76%). A quarter (n=33, 26%) reported poor adherence with anticoagulation therapy and 13.38% (n=17) reported complete warfarin cessation. While younger age was significantly associated with non-adherence to warfarin therapy (p=0.008), the independent predictors of people who discontinue warfarin completely were those not understanding why warfarin was needed (OR=9.97, p=0.006); a history of forgetting to take warfarin (OR=8.64, p=0.0013) and travel time to heart clinic >1 hour (OR=5.80, p=0.039). Conclusions While medication adherence is complex and multifactorial, the consequences of warfarin non-adherence are potentially catastrophic. These results provide an important first step towards the development of country-specific and disease-specific strategies to improve warfarin adherence.	en_US
dc.relation.ispartof	Heart Asia	en_US
dc.relation.isbasedon	10.1136/heartasia-2016-010751	en_US
dc.title	Predictors of warfarin non-adherence in younger adults after valve replacement surgery in the South Pacific	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	8	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1102 Cardiorespiratory Medicine and Haematology	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	8	en_US

Abstract:

Objectives Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings. This study sought to identify predictors of warfarin adherence after valve replacement surgery for RHD in Fiji (n=127). Methods A cross-sectional study design was used. Results The sample had a mean age of 31.23 years (SD 13.34) and a mean time-since-surgery of 3.72 years (SD 3.95). Just over half were women (n=71, 56%) and almost two-thirds were indigenous (I-taukei, n=78, 61%). Most had an isolated valve procedure (n=94, 74%) and at the time of survey, they were in New York Heart Association Class I (n=97, 76%). A quarter (n=33, 26%) reported poor adherence with anticoagulation therapy and 13.38% (n=17) reported complete warfarin cessation. While younger age was significantly associated with non-adherence to warfarin therapy (p=0.008), the independent predictors of people who discontinue warfarin completely were those not understanding why warfarin was needed (OR=9.97, p=0.006); a history of forgetting to take warfarin (OR=8.64, p=0.0013) and travel time to heart clinic >1 hour (OR=5.80, p=0.039). Conclusions While medication adherence is complex and multifactorial, the consequences of warfarin non-adherence are potentially catastrophic. These results provide an important first step towards the development of country-specific and disease-specific strategies to improve warfarin adherence.

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http://hdl.handle.net/10453/117196