Patient perspectives of prosthetic heart valve choice and anticoagulation in patients with rheumatic heart disease: a semi-quantitative study.

OBJECTIVE

To understand the factors that influence rheumatic heart disease (RHD) patients' prosthetic heart valve choice, their knowledge of anticoagulation and subsequent experience. This is the first RHD-specific data on valve choice, including high-deprivation populations.

METHODS

We performed a semi-quantitative, retrospective, cross-sectional survey study using a semi-structured telephone interview of patients (18-60 years) with RHD who had undergone valve replacement surgery from 2015 to 2020 at a single centre. Patients shared their experiences with prosthetic heart valves and warfarin.

RESULTS

138 patients completed or partially completed the survey from a total sample of 218 patients; mean age was 49 ± 10. 133 (61%) of patients had bioprosthetic valves implanted, and 85 (39%) had mechanical valves implanted. Younger and older patients were more likely to have bioprosthetic valves implanted, whereas middle-aged patients were more likely to have mechanical valves implanted. 38 (44%) of bioprosthetic valve patients specified warfarin avoidance, and 31 (62%) of mechanical valve patients specified avoidance of reoperation as their primary reason for choosing their respective valves (from 136 patients). 37 (43%) of bioprosthetic valve patients were informed that the durability of their valves would be at least 10-15 years (from 136 patients). The most helpful information providers regarding valve type were the surgeon and the cardiologist, whereas the GPs and cardiologists were for warfarin management. 64 (47%) had not seen a dentist, and 46 (34%) had not followed up with a cardiologist post-operatively (from 137 patients).

CONCLUSION

Many young RHD patients receive bioprosthetic valves; surgeons and cardiologists greatly influenced this choice. A uniform evidence-based education programme for health professionals may enhance decision-making around valve choice.

KEY FINDINGS: A large proportion of young RHD patients receive bioprosthetic valves, and surgeons and cardiologists greatly influenced this choice. Many patients also do not see a dentist or cardiologist following surgery. A uniform evidence-based education programme for health professionals may enhance decision-making around valve choice, and free dental care and robust follow-up pathways would ensure this vulnerable group of patients is not lost to follow-up.