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DOI: 10.1055/s-0029-1191454
Self-managed anticoagulation after mechanical heart valve replacement is superior to general practitioner management in health related quality of life
Objectives: The Early Self Controlled Anticoagulation Trial (ESCAT I) revealed that anticoagulation self-management (ASM) after mechanical heart valve replacement decreased anticoagulation related complication rates. Whether this is reflected by an improved health related quality of life (HRQL) has not been evaluated yet.
Methods: HRQL was measured (SF-36 questionnaire) in 1066 patients of the ESCAT I study population (mean age=59.5 y; ±10.2; n=864 aortic valve replacement [AVR]; 202 mitral valve replacement [MVR]; 549 patients were randomly assigned to ASM and 517 to general practitioner management [GPM]) before, 6, 12, 18, and 24 months after surgery. ANOVA was performed regarding valve position (AVR vs. MVR) and anticoagulation management (ASM vs. GPM), respectively and their interaction on HRQL.
Results: Postoperative SF-36 values increased significantly (p<0.001). AVR patients had higher values compared with MVR patients (p<0.005). All patients with ASM had significantly better scores in three physical (p<0.002) and in two mental SF-36 scales (p<0.04). Furthermore, the interaction between valve position and anticoagulation management revealed that patients after MVR benefit more from ASM than patients after AVR.
Conclusion: The ESCAT I trial showed a significant impact of ASM on HRQL after mechanical AVR and MVR during a 24 month follow-up. However, patients after MVR benefit the most from ASM. These data indicate that a more detailed subgroup analysis is mandatory to characterize a patient cohort who will benefit most from ASM after mechanical heart valve replacement.