Abstract
Background: Valvular heart disease (VHD) with calcification-induced aortic stenosis being the most common, followed by aortic regurgitation and mitral insufficiency. The 2020 ACC/AHA guidelines recommend vitamin K antagonists (VKAs), mainly warfarin, for patients with mechanical heart valves. Although VKAs are advised for anticoagulation after bioprosthetic valve replacement, literature from Germany, USA, and Japan reveals inconsistencies regarding direct oral anticoagulants (DOACs) in patients undergoing aortic or mitral valve replacement.
Purpose: This study evaluates anticoagulant adherence and adverse event rates in post-valve surgery patients using population-representative national data.
Study Design: We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort of VHD, including aortic stenosis, aortic regurgitation, and mitral insufficiency, who underwent valve replacement, and a diagnosis age of 65 years or older. The Cox proportional hazards model was used to compare risks associated with anticoagulant adherence.
Results: Of the 4,872 patients, 190 received DOACs, 2,805 were treated with warfarin, and 1,877 had no anticoagulation therapy. DOAC users were primarily in northern Taiwan, with higher comorbidity rates like hypertension and atrial fibrillation (AF). Patients with AF and in the northern region had higher medication adherence; diabetes and coronary artery disease showed no significant adherence impact (p>0.05). Mortality analysis indicated reduced risk in the DOAC group (Adjusted HR = 0.59, 95% CI 0.37-0.94, p=0.024). Age, particularly ≥85, significantly increased readmission (Adjusted HR = 1.98, 95% CI 1.58-2.48, p<0.001) and mortality (Adjusted HR = 3.86, 95% CI 2.97-5.02, p<0.001). Additionally, type 2 diabetes correlated with readmission risk (Adjusted HR = 1.37, 95% CI 1.22-1.53, p<0.001).
Conclusion: These findings provide valuable insights into anticoagulant adherence in post-valve replacement patients, highlighting the need for strategies to reduce adverse event rates and readmissions.
Sigma Membership
Lambda Beta at-Large
Type
Poster
Format Type
Text-based Document
Study Design/Type
Cohort
Research Approach
Quantitative Research
Keywords:
Academic-clinical Partnership, Valvular Heart Disease, Post-heart Valve Surgery, Older Adults, Aged, Taiwan
Recommended Citation
Han-Chang, Ku; Tzu-Jung, Chuang; and Yi-Lin, Wu, "Nationwide Cohort Study on Anticoagulant Adherence Post-Heart Valve Surgery in Older Adults" (2025). International Nursing Research Congress (INRC). 128.
https://www.sigmarepository.org/inrc/2025/posters_2025/128
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Nationwide Cohort Study on Anticoagulant Adherence Post-Heart Valve Surgery in Older Adults
Seattle, Washington, USA
Background: Valvular heart disease (VHD) with calcification-induced aortic stenosis being the most common, followed by aortic regurgitation and mitral insufficiency. The 2020 ACC/AHA guidelines recommend vitamin K antagonists (VKAs), mainly warfarin, for patients with mechanical heart valves. Although VKAs are advised for anticoagulation after bioprosthetic valve replacement, literature from Germany, USA, and Japan reveals inconsistencies regarding direct oral anticoagulants (DOACs) in patients undergoing aortic or mitral valve replacement.
Purpose: This study evaluates anticoagulant adherence and adverse event rates in post-valve surgery patients using population-representative national data.
Study Design: We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort of VHD, including aortic stenosis, aortic regurgitation, and mitral insufficiency, who underwent valve replacement, and a diagnosis age of 65 years or older. The Cox proportional hazards model was used to compare risks associated with anticoagulant adherence.
Results: Of the 4,872 patients, 190 received DOACs, 2,805 were treated with warfarin, and 1,877 had no anticoagulation therapy. DOAC users were primarily in northern Taiwan, with higher comorbidity rates like hypertension and atrial fibrillation (AF). Patients with AF and in the northern region had higher medication adherence; diabetes and coronary artery disease showed no significant adherence impact (p>0.05). Mortality analysis indicated reduced risk in the DOAC group (Adjusted HR = 0.59, 95% CI 0.37-0.94, p=0.024). Age, particularly ≥85, significantly increased readmission (Adjusted HR = 1.98, 95% CI 1.58-2.48, p<0.001) and mortality (Adjusted HR = 3.86, 95% CI 2.97-5.02, p<0.001). Additionally, type 2 diabetes correlated with readmission risk (Adjusted HR = 1.37, 95% CI 1.22-1.53, p<0.001).
Conclusion: These findings provide valuable insights into anticoagulant adherence in post-valve replacement patients, highlighting the need for strategies to reduce adverse event rates and readmissions.
Description
Among 4,872 patients, those on direct oral anticoagulants exhibited reduced mortality risk compared to warfarin. Advanced age and comorbidities, such as atrial fibrillation, significantly impacted readmission and mortality. The findings emphasize the importance of adherence strategies to decrease adverse events and improve post-surgical outcomes in valve replacement patients.