The Effects of a Telehealth Program on International Normalized Ratio Levels in Patients Undergoing Valvular Heart Surgery
DOI:
https://doi.org/10.60099/jtnmc.v39i03.268805Keywords:
telehealth program, international normalized ratio level, valvular heart surgeryAbstract
Introduction Patients undergoing heart valve surgery need to take warfarin, an anticoagulant with a narrow therapeutic index, which carries a high clinical risk if the International Normalized Ratio level (INR) is not within the target therapeutic range. This can lead to bleeding or blood clots. Continuous monitoring of INR levels is essential. A telehealth program provides education and manages care from initial treatment through discharge and ongoing follow-up consultations with the home healthcare team. This helps patients recognize the importance of proper medication use and maintain INR levels within the appropriate therapeutic range.
Objective To investigate the effects of a telehealth program on the international normalized ratio level in patients who underwent valvular heart surgery.
Design Quasi-experimental research with a two-group posttest design
Methodology The participants comprised 66 patients undergoing valvular heart surgery at a tertiary care hospital. The participants who met the inclusion criteria (n = 66) were randomly assigned to the control group (n=33) and the intervention group (n=33). The control group received only usual care. The intervention group received a usual care and telehealth program including knowledge about the disease, self-care practices, and medication details, as well as follow-up health monitoring at home and coordination with a multidisciplinary team for patient consultations via the Line application on smartphones. Data were collected using demographic data questionnaire, health condition, and International Normalized Ratio level (INR) record form. Data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation. An Independent t-test was used to compare the differences in INR levels between groups. Targeted INR were analyzed using a Chi-square test.
Results A mean of INR level in the intervention group on week 2 (M = 2.58, SD = 1.11) was lower than the control group (M = 3.33, SD = .1.21) significantly (t = 2.425, p = .018) and a mean of INR level on week 6 after discharge from hospital (M = 2.20, SD = 0.78) was lower than the control group (M = 3.19, SD = 1.16) significantly (t = 4.066, p <.001). In addition, the targeted INR level in the intervention group was significantly higher than that of the control group on week 6 after discharge from the hospital (c2 = 4.364, p = .037).
Recommendation Telehealth program combined with usual care can help patients undergoing valvular heart surgery to maintain their targeted INR levels. Therefore, nurses should integrate telehealth programs into their practice with follow-ups after discharge to ensure high-quality nursing care for patients.
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