Can we improve the detection of heart valve disease?

The clinical care of patients with valve disease is best organised by multidisciplinary specialist valve teams.1 ,2 These supervise inpatient and outpatient care, design protocols and processes and coordinate training and education. However, valve disease may not be detected or, if detected, a referral to a specialist team may not be made. This leads to preventable premature death.3 ,4 A working group was therefore convened by the British Heart Valve Society with representatives of all interested national bodies and a panel of invited international commentators. The overall aim was to produce recommendations to improve the detection, conservative management and interventional treatment of valve disease. This document focuses on the detection of valve disease. This occurs principally, but not exclusively, in the community. In the USA, the estimated prevalence of moderate or severe valve disease is 2.5% using population screening.3 By contrast, it was only 1.8% in a separate population when echocardiography was performed according to clinical indications.3 Although the two populations were different geographically and racially, this difference still points to clinically and statistically significant underdetection of valve disease. Similarly, there is major variation between observed and expected rates of aortic valve replacement in the UK5 which is likely to be as a result of differences in rates of detection and referral by general practitioners. Early detection of asymptomatic moderate or severe disease allows planned surveillance and optimal timing of surgery. By contrast, the EuroHeart survey6 found that approximately 50% of all patients having surgery for valve disease were in NYHA class III or IV which unnecessarily increases morbidity and mortality. Just under a third of patients with heart failure have valve disease7 and heart failure complicated 25% of admissions with aortic valve disease in Scotland between 1997 and 2005.4 …