[The Efficacy of the Smart-Rehabilitation Program in Patients After the Correction of Valvular Heart Diseases].

Aim      Comparative analysis of the effectiveness of a new approach, "SMART rehabilitation of patients after heart valve replacement", which includes, in addition to face-to-face training, Internet technologies in the form of video conferencing, the mobile application "Calculation of the warfarin dose", and a traditional program for educating patients after correction of valvular defects.Material and methods  The study included 190 patients with prosthetic heart valves. The main group consisted of 98 patients who completed a distance learning course. The control group included 92 patients participating in face-to-face training. Clinical and instrumental examinations (electrocardiography, echocardiography, determination of international normalized ratio (INR)), and surveys to evaluate awareness, compliance with treatment, and quality of life (QoL) were performed.Results At baseline, the awareness, compliance and QoL did not differ between the compared groups. After 6-month follow-up, the mean score of awareness increased by 53.6 % (р=0.0001). The compliance with treatment increased 3.3 times in the main group and 1.7 times in the control group (p=0.0247). Patients of the main group were more prone to self-management (p=0.0001), had better medical and social awareness (p=0.0335), medical and social communicability (p=0.0392), confidence in the therapeutic strategy of the attending physician (p=0.0001), and treatment effectiveness (p=0.0057). Analysis of QoL showed increases in living activity 2.1 times (р=0.0001), social functioning 1.6 times (р=0.0001), and mental health 1.9 times (р=0.0001).Conclusion      The novel approach of distance learning, "SMART rehabilitation of patients after heart valve replacement", provides improvements in awareness, compliance with treatment and QoL.

[Efficiency of pharmacogenetic approach to anticoagulant therapy in patients with prosthetic heart valves].

BACKGROUND: This study examined clinical, demographic, anthropometric, and inheritance factors that influence individual sensitivity to warfarin therapy after heart valve surgery. The clinical significance of the pharmacogenetic approach was assessed using the individual time frame and time spent in the INR therapeutic range. AIMS: We determined the clinical outcome of the pharmacogenetic approach at the start of warfarin therapy in patients with prosthetic heart valves. MATERIALS AND METHODS: The study included 915 patients, of which 512 women and 403 men (mean age 56±10 years), living in Western Siberia. Rheumatic heart disease was the main diagnosis that caused the acquired defect. Mechanical prostheses were used in 70% of cases of cardiac surgery. Real-time polymerase chain reaction used for molecular genetic testing. RESULTS: The frequencies of the alleles and genotypes of CYP2C9 and VKORC1 in the study population of patients with heart valves prosthetic correspond to the distribution in Caucasoid populations. The use of pharmacogenetic testing results at the beginning of warfarin therapy reduced the time required for selecting a therapeutic dose of anticoagulant by 2 times and increased the duration of stay in the INR therapeutic range by 20.2%. CONCLUSION: The use of the pharmacogenetic approach at the begin­ ning of warfarin therapy contributes to the effectiveness and safety of anticoagulant therapy in this category of patients.