EDITORIAL
Introduction to the British Heart Valve Society reviews Linked Comment: Rayner et al. Int J Clin Pract 2014; 68: 1209–15. Linked Comment: Ray and Chambers. Int J Clin Pract 2014; 68: 1216–20. Linked Comment: Coffey et al. Int J Clin Pract 2014; 68: 1221–6. Linked Comment: Chambers. Int J Clin Pract 2014; 68: 1227–30.
The epidemiology of valve disease is changing in industrially developed countries (1). Rheumatic fever has declined in importance since the 1960s and degenerative diseases, predominantly aortic stenosis and secondary mitral regurgitation, have become increasingly prevalent as our population ages. While some 2.5% of the population has moderate or severe valve disease, the prevalence is 13% in those aged over 75 years (2). At the same time, more can be done. There have been improvements in conventional surgical techniques and the development of transcatheter techniques has extended the ability to treat higher risk patients using stent-mounted aortic replacement valves for aortic stenosis and mitral clips for mitral regurgitation (3). However, we are increasingly aware of limitations in our care. Detection rates are low, and valve disease is, too often, first diagnosed at post-mortem. Aortic stenosis is still a cause of unexpected death at non-cardiac surgery or after trauma (4). General care and surveillance is patchy (5). Specialist valve clinics offer best-practice care (5,6), but too many patients are still seen by general cardiologists or general physicians without competencies in valve disease. As a result, one half of all patients in the EuroHeart Survey (7) had surgery in NYHA class III or IV while surgery is usually indicated as soon as symptoms develop (8,9) to avoid irreversible LV damage, Furthermore, at least one-third of elderly patients
References 1 Soler-Soler J, Galve E. Worldwide perspective of valve disease. Heart 2000; 83: 721–5. 2 Nkomo VT, Gardin JM, Skelton TN et al. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005–11. 3 Vahanian A, Alfieri O, Al-Attar N et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the EACTS and ESC in collaboration with EAPCI. Euro Heart J 2008; 29: 1463–70. 4 Olsson M, Rosenqvist M, Forssell G. Unnecessary deaths from valvular aortic stenosis. J Intern Med 1990; 228: 591–6.
ª 2014 John Wiley & Sons Ltd Int J Clin Pract, October 2014, 68, 10, 1175–1180
with aortic stenosis are not referred for surgery even when this is clinically indicated. Finally, access to expert surgery remains variable with huge differences in observed minus expected surgical rates across the UK (10). Mitral repair rate of up to 90% are expected for degenerative mitral valve disease, but repair rates are 41% in the US (11), 65% in the UK (10) and 50% in Europe (7). For all these reasons, valve disease has now become topical as the new “epidemic waiting to happen” (12). There are debates about the indications for biological rather than mechanical replacement valves, who should receive transcatheter aortic valves, whether there should be specialist valve surgeons. There is an acknowledgement that the evidence base for guidelines for valve disease is sparse and far more basic and clinical research is needed (13). This educational series has been commissioned from the British Heart Valve Society and aims to give an overview of the management of heart valve disease. The Society was founded in 2010 and aims to improve the care of patients with valve disease through: (i) Education and training; (ii) Research; (iii) Published articles. (iv) Working groups. More information can be found on its website (www.bhvs. org.uk).
British Heart Valve Society reviews
J. Chambers Cardiothoracic Centre, St Thomas’ Hospital, London, UK Email: [email protected]
5 Chambers J, Ray S, Prendergast B et al. Specialist valve clinics: recommendations from the British Heart Valve Society working group on improving quality in the delivery of care for patients with heart valve disease. Heart. doi:10.1136/heartjnl-2013-303754 6 Lancellotti P, Rosenhek R, Pibarot P et al. Heart valve clinics: organisation, structure and experiences. Eur Heart J in press; 2013; 34 (21): 1597–606. doi: 10.1093/eurheartj/ehs443. Epub 2013 Jan 4. 7 Iung B, Baron G, Butchart EG et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on valvular heart disease. Eur Heart J 2003; 24: 1231–43.
8 Vahanian A, Alfieri O, Andreotti F et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33: 2451–95. 9 Bonow RO, Carabello BA, Chatterjee K et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/ AHA 2006 guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol 2008; 52: e1–142. 10 Bridgewater B, Kinsman R, Walton P et al. Demonstrating Quality: The Sixth National Adult Cardiac Surgery Database Report. Henley on Thomas, UK: Dendrite Clinical Systems Ltd, 2009.
1180
Editorials
11 Bolling SF, Li S, O’Brien SM, Brennan JM, Prager RL, Gammie JS. Predictors of mitral valve repair: clinical and surgeon factors. Ann Thoracic Surg 2010; 90: 1904–11. 12 d’Arcy JL, Prendergast BD, Chambers JB et al. Valvular heart disease: the next epidemic. Heart 2011; 97: 91–3.
13 Chambers JB, Shah BN, Prendergast B et al. Valvular heart disease: a call for global collaborative research initiatives. Heart. doi:10.1136/heartjnl-2013-303964
Disclosure Authors have nothing to disclose. doi: 10.1111/ijcp.12224
Funding and acknowledgements There was no funding.
ª 2014 John Wiley & Sons Ltd Int J Clin Pract, October 2014, 68, 10, 1175–1180
Introduction to the British Heart Valve Society reviews Linked Comment: Rayner et al. Int J Clin Pract 2014; 68: 1209–15. Linked Comment: Ray and Chambers. Int J Clin Pract 2014; 68: 1216–20. Linked Comment: Coffey et al. Int J Clin Pract 2014; 68: 1221–6. Linked Comment: Chambers. Int J Clin Pract 2014; 68: 1227–30.
The epidemiology of valve disease is changing in industrially developed countries (1). Rheumatic fever has declined in importance since the 1960s and degenerative diseases, predominantly aortic stenosis and secondary mitral regurgitation, have become increasingly prevalent as our population ages. While some 2.5% of the population has moderate or severe valve disease, the prevalence is 13% in those aged over 75 years (2). At the same time, more can be done. There have been improvements in conventional surgical techniques and the development of transcatheter techniques has extended the ability to treat higher risk patients using stent-mounted aortic replacement valves for aortic stenosis and mitral clips for mitral regurgitation (3). However, we are increasingly aware of limitations in our care. Detection rates are low, and valve disease is, too often, first diagnosed at post-mortem. Aortic stenosis is still a cause of unexpected death at non-cardiac surgery or after trauma (4). General care and surveillance is patchy (5). Specialist valve clinics offer best-practice care (5,6), but too many patients are still seen by general cardiologists or general physicians without competencies in valve disease. As a result, one half of all patients in the EuroHeart Survey (7) had surgery in NYHA class III or IV while surgery is usually indicated as soon as symptoms develop (8,9) to avoid irreversible LV damage, Furthermore, at least one-third of elderly patients
References 1 Soler-Soler J, Galve E. Worldwide perspective of valve disease. Heart 2000; 83: 721–5. 2 Nkomo VT, Gardin JM, Skelton TN et al. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005–11. 3 Vahanian A, Alfieri O, Al-Attar N et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the EACTS and ESC in collaboration with EAPCI. Euro Heart J 2008; 29: 1463–70. 4 Olsson M, Rosenqvist M, Forssell G. Unnecessary deaths from valvular aortic stenosis. J Intern Med 1990; 228: 591–6.
ª 2014 John Wiley & Sons Ltd Int J Clin Pract, October 2014, 68, 10, 1175–1180
with aortic stenosis are not referred for surgery even when this is clinically indicated. Finally, access to expert surgery remains variable with huge differences in observed minus expected surgical rates across the UK (10). Mitral repair rate of up to 90% are expected for degenerative mitral valve disease, but repair rates are 41% in the US (11), 65% in the UK (10) and 50% in Europe (7). For all these reasons, valve disease has now become topical as the new “epidemic waiting to happen” (12). There are debates about the indications for biological rather than mechanical replacement valves, who should receive transcatheter aortic valves, whether there should be specialist valve surgeons. There is an acknowledgement that the evidence base for guidelines for valve disease is sparse and far more basic and clinical research is needed (13). This educational series has been commissioned from the British Heart Valve Society and aims to give an overview of the management of heart valve disease. The Society was founded in 2010 and aims to improve the care of patients with valve disease through: (i) Education and training; (ii) Research; (iii) Published articles. (iv) Working groups. More information can be found on its website (www.bhvs. org.uk).
British Heart Valve Society reviews
J. Chambers Cardiothoracic Centre, St Thomas’ Hospital, London, UK Email: [email protected]
5 Chambers J, Ray S, Prendergast B et al. Specialist valve clinics: recommendations from the British Heart Valve Society working group on improving quality in the delivery of care for patients with heart valve disease. Heart. doi:10.1136/heartjnl-2013-303754 6 Lancellotti P, Rosenhek R, Pibarot P et al. Heart valve clinics: organisation, structure and experiences. Eur Heart J in press; 2013; 34 (21): 1597–606. doi: 10.1093/eurheartj/ehs443. Epub 2013 Jan 4. 7 Iung B, Baron G, Butchart EG et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on valvular heart disease. Eur Heart J 2003; 24: 1231–43.
8 Vahanian A, Alfieri O, Andreotti F et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33: 2451–95. 9 Bonow RO, Carabello BA, Chatterjee K et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/ AHA 2006 guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol 2008; 52: e1–142. 10 Bridgewater B, Kinsman R, Walton P et al. Demonstrating Quality: The Sixth National Adult Cardiac Surgery Database Report. Henley on Thomas, UK: Dendrite Clinical Systems Ltd, 2009.
1180
Editorials
11 Bolling SF, Li S, O’Brien SM, Brennan JM, Prager RL, Gammie JS. Predictors of mitral valve repair: clinical and surgeon factors. Ann Thoracic Surg 2010; 90: 1904–11. 12 d’Arcy JL, Prendergast BD, Chambers JB et al. Valvular heart disease: the next epidemic. Heart 2011; 97: 91–3.
13 Chambers JB, Shah BN, Prendergast B et al. Valvular heart disease: a call for global collaborative research initiatives. Heart. doi:10.1136/heartjnl-2013-303964
Disclosure Authors have nothing to disclose. doi: 10.1111/ijcp.12224
Funding and acknowledgements There was no funding.
ª 2014 John Wiley & Sons Ltd Int J Clin Pract, October 2014, 68, 10, 1175–1180
