Educational self-care interventions post-valve surgery improved anticoagulation, reducing thromboembolic and hemorrhagic events, and increased INR stability in 73% of studies.
Do self-care educational interventions improve self-care behaviors and clinical outcomes in post-valve surgery patients?
Educational interventions targeting self-care behaviors improve clinical outcomes, including INR stability and reduced bleeding/thromboembolic complications, in patients following heart valve surgery.
Abstract Background Valvular heart disease (VHD) is a growing global health concern, with rising prevalence in aging populations. Surgical valve replacement remains the primary treatment of VHD, requiring effective self-care to optimize outcomes and prevent complications (e.g., thromboembolism, prosthetic valve dysfunction, hospital readmissions). Despite self-care’s critical role, its impact on post-surgical recovery in patients with VHD remains insufficiently explored. Purpose This systematic review assesses the effectiveness of educational interventions in improving self-care behaviors and clinical outcomes in heart valve surgery patients, while mapping intervention types and characteristics. Methods Following PRISMA guidelines, we conducted a comprehensive search in PubMed, Scopus, Web of Science, and CINAHL for randomized controlled trials (RCTs) evaluating self-care educational interventions in post-valve surgery patients. Inclusion criteria focused on interventions targeting self-care maintenance (i.e., behaviors to maintain VHD stability), self-care monitoring (i.e., tracking signs and symptoms of exacerbations), and self-care management (i.e., responses to symptoms), based on the Middle-Range Theory of Self-Care. Results We selected 15 RCTs involving 9,110 patients (mean age: 57.9 years, SD=5.6; 53% male), mostly targeting mechanical heart valve patients. All educational interventions were face-to-face (n=15, 100%), with some incorporating technology-based and telephone support (n=3, 20%). Behavioral techniques included goal setting (n=12, 80%) and problem-solving (n=5, 33%). Self-care interventions improved anticoagulation, reducing thromboembolic (n=5, 33%) and hemorrhagic complications (n=7, 47%), and increasing INR stability (n=11, 73%). Interventions targeted self-care maintenance (e.g., physical activities, diet, lifestyle, psychosocial aspects; n=3, 20%), self-care monitoring (e.g., INR self-testing, physical activity, vital signs, diet; n=15, 100%), and self-care management (e.g., medication adjustments, dietary changes, symptom control; n=15, 100%). Additional improvements were seen in quality of life (n=6, 40%), pain (n=1, 7%), mental health (n=2, 13%), self-efficacy (n=4, 27%), and therapy adherence (n=4, 27%). Conclusions Evidence suggests educational interventions enhance self-care behaviors and clinical outcomes in VHD patients’ post-surgery. However, effectiveness varies due to differences in design, delivery, and patient engagement. Future research should optimize self-care strategies via personalized, tech-assisted interventions for long-term behaviors and better outcomes.
Dollaku et al. (2025) studied this question. Educational self-care interventions post-valve surgery improved anticoagulation, reducing thromboembolic and hemorrhagic events, and increased INR stability in 73% of studies.