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John Chambers
Emeritus Professor of Clinical Cardiology at Guy’s and St Thomas’ NHS Foundation Trust
The public needs to have a greater awareness of heart valve disease, a predominantly age-related condition which can be potentially fatal if left undiagnosed and untreated.
It is estimated that 1.5 million people in the UK have significant heart valve disease, a potentially fatal condition which is increasingly common above the age of 65.
Irreversible damage to heart chambers
Among the public, heart valve disease may not be as well-known as other cardiac conditions, such as angina or heart failure. That needs to change, insists John Chambers, Emeritus Professor of Clinical Cardiology at Guy’s and St Thomas’ NHS Foundation Trust, particularly because heart valve disease is a predominantly age-related disease — and, as we are all living longer, more of us will be affected by it.
“People need to understand that valve disease can cause irreversible damage to the pumping chambers of the heart and is an important underlying cause of heart failure,” he says. “Indeed, undetected aortic valve diseases affect 10% of heart failure patients. As such, it requires much wider attention than it currently receives.”
Causes of valve disease and available treatments
Professor Chambers explains: “The heart has four valves — aortic, mitral, pulmonary and tricuspid — which open to let blood flow in and then close to prevent reflux when the heart contracts. As we age, the aortic valve can progressively degenerate and calcify, restricting healthy blood flow; while a weakness of the mitral valve can prevent it from closing completely, causing blood to flow in the wrong direction. Apart from age, heart valve disease can be caused by congenital abnormalities and infections such as rheumatic fever and infective endocarditis — so it affects younger people too.”
The good news, according to Professor Chambers, is that “treatment is available and includes valve repair or replacement procedures. Where surgery is not suitable, a transcatheter aortic valve implantation (TAVI) procedure may be used to insert an artificial replacement valve into the heart.”
Heart valve disease is a predominantly age-related disease — and, as we are all living longer, more of us will be affected by it.
Why diagnosis times and care must be optimised
The challenge is catching heart valve disease in time. “Patients often display no symptoms in the early stages of the condition, so it can be a silent killer. Valve disease is only detected in about one-half of patients,” says Professor Chambers.
“It’s so important for clinicians to check their patients for signs of a heart murmur. Anyone with a murmur or other cardiac symptoms can then be referred on for a relatively quick ultrasound scan to determine if more extensive scans — such as an ECG (electrocardiogram) — are needed.” Speed is key because, apart from increasing surgical risks, later diagnosis can limit recovery.
Another issue that needs addressing is that care for valve disease is often still performed by physicians without specialist competencies in the condition. “Each healthcare location should have a dedicated specialist who is able to read the latest valve disease guidelines and research,” says Professor Chambers. “Only 66% of cardiac centres have valve clinics. These clinics, or the requirement for specialist competencies, need to be universal.”
Importance of patient education and engagement
Finally, patient education and engagement should be improved. “Education regarding the disease should occur by a discussion with the patient over some time,” says Professor Chambers.
“The clinician can then advise the patient about the treatment options open to them, while the patient can educate the clinician about the type of treatment they want. Overall, results will be better if patients are involved in decision-making.”
This is why it’s important that patients understand as much about the condition as possible, stresses Professor Chambers. “They can be in a better position to assimilate information, ask questions, challenge decisions and, ultimately, drive up medical standards. I feel very strongly that the way forward must include educated and engaged patients.”
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