Currently submitted to: JMIR mHealth and uHealth
Date Submitted: Jun 24, 2026
Open Peer Review Period: Jun 24, 2026 - Aug 19, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness, Safety, and Cost-Utility of the WeChat Group Supported Patient Self-Management for Warfarin Therapy: A Prospective Nonrandomized Controlled Study
ABSTRACT
Background:
Low-cost social-media support and patient self-management (PSM) may improve lifelong warfarin management after mechanical heart valve replacement (MHVR), but their incremental value in China is uncertain.
Objective:
To investigate the effectiveness of the pharmacist-led WeChat Group support to usual care (UC) as well as to compare PSM with UC when both groups received WeChat Group supports.
Methods:
This prospective, single-center, nonrandomized controlled trial recruited adults receiving long-term warfarin from participants who had completed the previous multicenter SMART trial. Participants from the SMART patient self-testing (PST) group willing to use PSM and passed assessment were included in the PSM group. Participants from the SMART UC group were matched and included in the UC group. Participants were followed up for 12 months. Both groups received pharmacist-led WeChat Group education and consultation. PSM participants also measured INR at home and independently adjusted warfarin dosage; UC participants continued physician-directed outpatient management. The primary outcome was TTR. Secondary outcomes included major bleeding, thromboembolism, all-cause death, extreme INR results, and modeled lifetime cost-utility.
Results:
The study included 182 participants (91 per group) and 179 completed follow-ups. TTR were significantly increased compared to baseline (71.44% vs 66.24%; P=.001) in both PSM and UC (69.60% vs 63.79%; P=.04) groups, but 12-month TTR (71.44% vs 69.60%; P=.48) and changes from baseline (5.21% vs 5.81%; P=.89) did not differ significantly between two groups. Compared to UC group, INR results below 1.50 were significantly less frequent (3.38% vs 5.62%; P=.01), yet major bleeding (1.10% vs 4.40%; P=.17) and thromboembolism (1.10% vs 3.30%; P=.31) didn’t differ significantly. The modeled incremental cost-utility ratio for PSM was CNY 1179.25 per quality-adjusted life-year, with a 92.9% probability of cost-effectiveness at the prespecified threshold.
Conclusions:
Among MHVR patients with favorable baseline TTR levels, adding pharmacist-led WeChat Group education and consultation may improve TTR in UC. With both groups receiving WeChat Group support, PSM did not further improve TTR or significantly reduce clinical events, but was associated with fewer severely subtherapeutic INR results and favorable modeled cost-utility. Larger randomized studies are needed. Clinical Trial: Trial Registration: Chinese Clinical Trial Registry ChiCTR2400091337
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.