Heart Valve Disease and Treatment Pathway in the Elderly

Based on an article title “ Creating a better journey of care for patients with heart valve disease”

Originally written by Sitges et al., 2021

https://academic.oup.com/ehjopen/article/1/3/oeab034/6423986

By Murielle Nsiela 

Introduction to Heart Valve Disease

Heart valve disease is said to be the next cardiac epidemic, with its prevalence estimated to double by 2040 and triple in the year 2060. This comes as a result of ageing populations.¹ Despite these statistics, heart valve disease is limited in research, data, and general awareness compared to other cardiovascular diseases. As a result, a multidisciplinary group of patients and clinical experts in heart valve disease gathered to raise awareness of the unmet medical need of patients with the disease. Heart valve disease happens when any of the valves in the heart are damaged or diseased. 

What are Heart Valves?

There are four valves in the heart, and the main responsibility of the valves is to regulate blood entering and leaving the heart. A healthy valve can fully open and close when a heartbeat occurs. However, a valve that is diseased or damaged will only open and close partially. Any of the four valves can become diseased, however a valve known as the aortic valve is affected the most.²

What is the Recommended Treatment Pathway?

The disease can take different forms, and each of these types of heart valve disease should have its own diagnostic and treatment process.³ Most types of heart valve disease have efficient treatment options that can improve patients’ quality of life and also decrease mortality with timely valve replacement. However, in many patients, this disease goes undiagnosed, undetected, or untreated. This leads to preventable deaths, compromised quality of life, and expenses that could have been avoided.⁴

Furthermore, it has been suggested that under-detection is a major concern in heart valve disease, as the symptoms of the disease are proven to be challenging to identify and could be confused with regular signs of ageing. In addition, heart valve disease is sometimes symptomless. An OX-valve study within the UK found that out of 2,500 individuals aged 65 and over registered in primary care centres, 11.3% of them either had moderate or severe heart valve disease.⁵ Most of these issues can be alleviated by focusing on the gaps present in the patient's treatment pathway.

A recommended patient pathway involves:⁵

A - Awareness - Develop campaigns for public awareness 

D - Detection - Train primary care practitioners for early detection of heart valve disease 

D - Diagnosis - Fast referrals for echocardiograms

T - Treatment - Appropriate selection of treatment method, treatment should be individualised 

F - Follow-ups and monitoring - Provide psychological support and nursing care 

Conclusion

In conclusion, patients with suspected heart valve disease should have their heart scanned and referred to a specialist physician as soon as possible to avoid delayed detection. In addition, the recommended patient care pathway should be adhered to for the best patient outcome.

References: 

  1. d’Arcy J, Prendergast B, Chambers J, Ray S, Bridgewater B. Valvular heart disease: the next cardiac epidemic. Heart 2011;97:91-93.
  2. CDC, 2022 - CDC. Valvular Heart Disease | cdc.gov [Internet]. Centres for Disease Control and Prevention. 2022 [cited 19 January 2022]. Available from: https://www.cdc.gov/heartdisease/valvular_disease.htm
  3. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L,D, Bonis MD, Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Ju ̈ni P, Pierard L, Prendergast BD, Sa ́daba JR, Tribouilloy C, Wojakowski W. ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021;2060:727—800.
  4. Clark MA, Arnold SV, Duhay FG, Thompson AK, Keyes MJ, Svensson LG, Bonow RO, Stockwell BT, Cohen DJ. Five-year clinical and economic outcomes among patients with medically managed severe aortic stenosis: results from a Medicare claims analysis. Circ Cardiovasc Qual Outcomes 2012;5:697—704.
  5. d’Arcy JL, Coffey S, Loudon MA, Kennedy A, Pearson-Stuttard J, Birks J, Frangou E, Farmer AJ, Mant D, Wilson J, Myerson SG, Prendergast BD. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study. Eur Heart J 2016;37:3515—3522.
  6. Sitges M, Borregaard B, De Paulis R, Nolan P, Woan W, Pearce K et al. Creating a better journey of care for patients with heart valve disease. European Heart Journal Open. 2021;1(3).

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Murielle Nsiela

MSc Graduate in Medical Engineering - Bachelor's degree, Pharmaceutical Science, Keele University, Staffordshire UK

MSc in Medical Engineering Design, Keele University Modules included: Advanced engineering applications, Engineering for medical applications report, Bioreactors and Growth environment, Creative engineering design, Experimental research methodology and research projects



BSc (Hons) Pharmaceutical Science, Technology and Business, Keele University Modules included: Core topics in pharmaceutical science, Laboratory studies - tabletting and liposomes report, applied Pharmaceutical Science 2, Pharmaceutical research project

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