{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T17:17:45Z","timestamp":1778260665306,"version":"3.51.4"},"reference-count":26,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart Asia"],"accepted":{"date-parts":[[2016,5,17]]},"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings. This study sought to identify predictors of warfarin adherence after valve replacement surgery for RHD in Fiji (n=127).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cross-sectional study design was used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The sample had a mean age of 31.23\u2005years (SD 13.34) and a mean time-since-surgery of 3.72\u2005years (SD 3.95). Just over half were women (n=71, 56%) and almost two-thirds were indigenous (I-taukei, n=78, 61%). Most had an isolated valve procedure (n=94, 74%) and at the time of survey, they were in New York Heart Association Class I (n=97, 76%). A quarter (n=33, 26%) reported poor adherence with anticoagulation therapy and 13.38% (n=17) reported complete warfarin cessation. While younger age was significantly associated with non-adherence to warfarin therapy (p=0.008), the independent predictors of people who discontinue warfarin completely were those not understanding why warfarin was needed (OR=9.97, p=0.006); a history of forgetting to take warfarin (OR=8.64, p=0.0013) and travel time to heart clinic &gt;1\u2005hour (OR=5.80, p=0.039).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>While medication adherence is complex and multifactorial, the consequences of warfarin non-adherence are potentially catastrophic. These results provide an important first step towards the development of country-specific and disease-specific strategies to improve warfarin adherence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartasia-2016-010751","type":"journal-article","created":{"date-parts":[[2016,6,15]],"date-time":"2016-06-15T09:14:11Z","timestamp":1465982051000},"page":"18-23","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Predictors of warfarin non-adherence in younger adults after valve replacement surgery in the South Pacific"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0362-3946","authenticated-orcid":false,"given":"Linda J","family":"Thomson Mangnall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3561-9447","authenticated-orcid":false,"given":"David W","family":"Sibbritt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nihaya","family":"Al-Sheyab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5588-9351","authenticated-orcid":false,"given":"Robyn D","family":"Gallagher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,6,14]]},"reference":[{"key":"2025090723002146000_8.2.18.1","unstructured":"Carapetis J , Brown A , Walsh W , et al . Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australia. An evidence-based review. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, 2006."},{"key":"2025090723002146000_8.2.18.2","unstructured":"World Health Organization. WHO expert consultation on rheumatic fever and rheumatic heart disease. WHO technical report series: 923. Geneva, Switzerland: World Health Organization, 2004."},{"key":"2025090723002146000_8.2.18.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu449"},{"key":"2025090723002146000_8.2.18.4","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1017\/S1047951107001734","article-title":"The high burden of rheumatic heart disease found on autopsy in Fiji","volume":"18","author":"Singh","year":"2008","journal-title":"Cardiol Young"},{"key":"2025090723002146000_8.2.18.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.537"},{"key":"2025090723002146000_8.2.18.6","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1016\/j.jtcvs.2014.02.006","article-title":"Short- and long-term outcomes after valve replacement surgery for rheumatic heart disease in the South Pacific, conducted by a fly-in\/fly-out humanitarian surgical team: a 20-year retrospective study for the years 1991 to 2011","volume":"148","author":"Thomson Mangnall","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025090723002146000_8.2.18.7","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu365"},{"key":"2025090723002146000_8.2.18.8","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.121162"},{"key":"2025090723002146000_8.2.18.9","unstructured":"Sabate E (Ed). Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003. (Report available at: http:\/\/www.who.int\/chp\/knowledge\/publications\/adherence_full_report.pdf)."},{"key":"2025090723002146000_8.2.18.10","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.3_suppl.204S"},{"key":"2025090723002146000_8.2.18.11","unstructured":"Horne R , Weinman J , Barber N , et al . Concordance, adherence and compliance in medicine taking. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO). London, UK: NHS National Coordinating Centre for Service Delivery and Organisation (NCCSDO), 2005:1\u2013311."},{"key":"2025090723002146000_8.2.18.12","first-page":"51","article-title":"Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thromboembolism","volume":"4","author":"Kneeland","year":"2010","journal-title":"Patient Prefer Adherence"},{"key":"2025090723002146000_8.2.18.13","doi-asserted-by":"publisher","DOI":"10.1592\/phco.2005.25.12.1801"},{"key":"2025090723002146000_8.2.18.14","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1556"},{"key":"2025090723002146000_8.2.18.15","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1093\/ajhp\/61.12.1258","article-title":"Effect of warfarin nonadherence on control of the International Normalized Ratio","volume":"61","author":"Waterman","year":"2004","journal-title":"Am J Health Syst Pharm"},{"key":"2025090723002146000_8.2.18.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(97)90048-6"},{"key":"2025090723002146000_8.2.18.17","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E464"},{"key":"2025090723002146000_8.2.18.18","doi-asserted-by":"publisher","DOI":"10.1378\/chest.127.5.1515"},{"key":"2025090723002146000_8.2.18.19","first-page":"354","article-title":"Pattern of anticoagulation control after heart valve surgery at the Kenyatta National Hospital, Nairobi","volume":"77","author":"Ogendo","year":"2000","journal-title":"East Afr Med J"},{"key":"2025090723002146000_8.2.18.20","unstructured":"Wyber R , Grainger Gasser A , Thompson D , et al . Tools for Implementing RHD Control Programmes (TIPS) handbook. 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