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  • Educational Series on the Specialist Valve Clinic
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What is a valve clinic?

Abstract

The prevalence of heart valve disease is increasing as the population ages. A series of studies have shown current clinical practice is sub-optimal. Some patients are referred for surgery at advanced stages of disease with impaired ventricular function or not even considered for surgery. Valve clinics seek to improve patient outcomes by providing an expert-led, patient-centred framework of care designed to provide an accurate diagnosis with active surveillance of valve pathology and timely referral for intervention at guideline directed trigger points. A range of different valve clinic models can be adopted depending on local expertise combining the skill set of cardiologist, physiologist/scientist and nurses. Essential components to all clinics include structured clinical review, echocardiography to identify disease aetiology and severity, patient education and access to both additional diagnostic testing and a multi-disciplinary meeting for complex case review. Recommendations for training in heart valve disease are being developed. There is a growing evidence base for heart valve clinics providing better care with increased adherence to guideline recommendations, more timely referral for surgery and better patient education than conventional care.

References

  1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG & Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006368. https://doi.org/10.1016/S0140-6736(06)69208-8)

  2. d’Arcy JL, Coffey S, Loudon MA, Kennedy A, Pearson-Stuttard J, Birks J, Frangou E, Farmer AJ, Mant D, Wilson J, et al. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study. European Heart Journal 201637. https://doi.org/10.1093/eurheartj/ehw229)

  3. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. European Heart Journal 200324. https://doi.org/10.1016/S0195-668X(03)00201-X)

  4. Mirabel M, Iung B, Baron G, Messika-Zeitoun D, Détaint D, Vanoverschelde JL, Butchart EG, Ravaud P, & Vahanian A. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? European Heart Journal 200728. https://doi.org/10.1093/eurheartj/ehm001)

  5. Bach DS, Awais M, Gurm HS, & Kohnstamm S. Failure of guideline adherence for intervention in patients with severe mitral regurgitation. Journal of the American College of Cardiology 200954. https://doi.org/10.1016/j.jacc.2009.03.079)

  6. Bhattacharyya S, Pavitt C, Lloyd G, Chambers JB & British Heart Valve Society. Provision, organization and models of heart valve clinics within the United Kingdom. QJM 2015108. https://doi.org/10.1093/qjmed/hcu164)

  7. Chambers JB, Ray S, Prendergast B, Taggart D, Westaby S, Grothier L, Arden C, Wilson J, Campbell B, Sandoe J, 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 201399. https://doi.org/10.1136/heartjnl-2013-303754)

  8. Lancellotti P, Rosenhek R, Pibarot P, Iung B, Otto CM, Tornos P, Donal E, Prendergast B, Magne J, La Canna G, et al. ESC Working Group on valvular heart disease position paper–heart valve clinics: organization, structure, and experiences. European Heart Journal 201334. https://doi.org/10.1093/eurheartj/ehs443)

  9. Taggu W, Topham A, Hart L, Carr-White G, Sulke N, Patel NR & Lloyd G. A cardiac sonographer led follow up clinic for heart valve disease. International Journal of Cardiology 2009132. https://doi.org/10.1016/j.ijcard.2007.11.076)

  10. Parkin DH & Chambers JB. What is the value of a nurse-led clinic for patients with replacement heart valves? British Journal of Cardiac Nursing 201510. https://doi.org/10.12968/bjca.2015.10.3.145)

  11. McLachlan A, Sutton T, Ding P & Kerr A. A nurse practitioner clinic: a novel approach to supporting patients following heart valve surgery. Heart, Lung and Circulation 201524. https://doi.org/10.1016/j.hlc.2015.04.064)

  12. Badiani S, Waddingham P, Lloyd G & Bhattacharyya S. Stress echocardiography in valvular heart disease. Expert Review of Cardiovascular Therapy 201816. https://doi.org/10.1080/14779072.2018.1532791)

  13. Bhattacharyya S, Pavitt C, Lloyd G, Chambers JB & British Heart Valve Society. Prevalence and composition of heart valve multi-disciplinary teams within a national health system. International Journal of Cardiology 2014177. https://doi.org/10.1016/j.ijcard.2014.08.070)

  14. Chambers J, Campbell B, Wilson J, Arden C & Ray S. How should specialist competencies in heart valve disease be recognized? QJM 2015108. https://doi.org/10.1093/qjmed/hcv002)

  15. Ionescu A, McKenzie C & Chambers JB. Are valve clinics a sound investment for the health service? A cost-effectiveness model and an automated tool for cost estimation. Open Heart 20152 e000275. https://doi.org/10.1136/openhrt-2015-000275)

    Article  Google Scholar 

  16. Zilberszac R, Lancellotti P, Gilon D, Gabriel H, Schemper M, Maurer G, Massetti M & Rosenhek R. Role of a heart valve clinic programme in the management of patients with aortic stenosis. European Heart Journal Cardiovascular Imaging 201718. https://doi.org/10.1093/ehjci/jew133)

  17. Lancellotti P, Magne J, Dulgheru R, Clavel MA, Donal E, Vannan MA, Chambers J, Rosenhek R, Habib G, Lloyd G, et al. Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics. JAMA Cardiology 20183. https://doi.org/10.1001/jamacardio.2018.3152)

  18. Zilberszac R, Heinze G, Binder T, Laufer G, Gabriel H & Rosenhek R. Long-term outcome of active surveillance in severe but asymptomatic primary mitral regurgitation. JACC: Cardiovascular Imaging 201811. https://doi.org/10.1016/j.jcmg.2018.05.014)

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Correspondence to Sanjeev Bhattacharyya MD FESC.

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This paper is part of a series on specialist valve clinics. The Guest Editors for this series were Richard P Steeds and John B Chambers.

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Bhattacharyya, S., Parkin, D. & Keith, P. What is a valve clinic?. Echo Res Pract 6, T7–T13 (2019). https://doi.org/10.1530/ERP-18-0086

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