Screening for unrecognised heart valve disease

What is heart valve disease and why screening may help

Heart valve disease or valvular heart disease (VHD) is the name given to problems with one or more of the heart’s four valves. In a heart which is working normally, valves keep blood flowing in the right direction and entering or leaving the heart’s chambers only at the right time. Heart valve disease can develop before birth, in which case it is called ‘congenital’. It can also be caused by the effects of certain infections, such as rheumatic fever, or by age-related “wear and tear”. The four valves are called the mitral, tricuspid, aortic and pulmonic valves.
 
Narrowing of the valve means it does not open fully and so the blood cannot flow through properly: this is known as stenosis. The most common cause of valve stenosis in older people is a build-up of calcium. Calcium is a mineral present in the blood, and over time as blood flows through the valve, tiny amounts of calcium may start to build up. As a result, the valves become stiff and cannot open or close fully. This is quite normal and happens to most of us as we get older, to a greater or lesser degree.
 
If the valve does not close properly blood can leak backwards' this is known as regurgitation. This could happen for one of several reasons, including general wear and tear, an infection, a congenital problem, or damage from a previous heart attack.
 
Why might screening be important?
 
Symptoms of heart valve disease vary from person to person, and are usually not obvious until the disease is quite advanced and needs medical or surgical treatment. This means we do not know how many people are living with heart valve disease without realising they have it, or what happens to them in the longer term.
 
All the people we interviewed were taking part in a new research study which is screening people aged over 65 to find out how common heart valve disease is. At present, screening for heart valve disease is not available to everyone throughout the UK.
 
Most people will have only one scan and will be told they have no valve disease. Anyone who is found to have the condition will be asked back for a second visit. (See also ‘The screening appointment – having the heart scan’ and ‘Attending follow up appointments’).
 
One of the aims of the study is to find out whether early diagnosis and treatment of heart valve disease can improve the care pathways and health of patients in the long term.
 
What treatment is available for heart valve disease?
 
As Jo d’Arcy points out above, most people with mild forms of heart valve disease will not need treatment, but anyone who does need treatment during the course of the research will be offered it. Available treatments at present mostly involve surgery (either an operation to repair or widen the existing valve, or replacement with a new artificial valve).

Update 2016

The study has now completed recruitment at just over 4000 patients (over 65 years of age) recruited from 7 participating GP surgeries in Oxfordshire. Most participants found the scanning process acceptable, without causing undue anxiety, and the vast majority of participants (more than 95%) said they would have echo screening again.

The study team have analysed the data from the first 2500 patients recruited and recently had these results published in the European Heart Journal, June 2016. doi:10.1093/eurheartj/ehw229

The data showed that newly diagnosed (predominantly mild and unlikely to ever cause any harm) VHD was found in 51% of participants, of which 6.4 % was found to be moderate/ severe, being clinically significant and requiring further intervention or monitoring. Previously undiagnosed VHD was found to be more common in lower socioeconomic groups, and affects 1 in 2 of the elderly population, prevalence increases with age.

Phase two of the study will be commencing in the Autumn of 2016, conducting the 5 year follow up visits for those participants who have previously taken part in the study. Visits will be conducted at GP surgeries as before, and patients will be invited to attend for their follow up echo (heart scan). This visit will be similar to the first visit. An information sheet will be sent to all patients with their invite explaining the visit and what is involved in more detail. 


Last reviewed August 2016.
Last updated August 2016.

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