Bernard Iung1, Victoria Delgado2, Patrice Lazure3, Suzanne Murray3, Per Anton Sirnes4, Raphael Rosenhek5, Susanna Price6, Marco Metra7, Céline Carrera8, Michele De Bonis9, Michael Haude10, Gerhard Hindricks11, Jeroen Bax2, Alec Vahanian1. 1. AP-HP, Cardiology Department, Bichat Hospital, Paris-Diderot University, DHU Fire, 46 rue Henri Huchard, 75018 Paris, France. 2. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. 3. AXDEV Group Inc., 210-8, Place du Commerce, Brossard, Quebec J4W 3H2, Canada. 4. Cardiology Practice, Østlandske Hjertesenter, Triovingv. 3, 1523 Moss, Norway. 5. Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. 6. Unit of Critical Care, Royal Brompton & Harefield NHS Trust, Sydney Street, London SW3 6NP, UK and National Heart & Lung Institute, Imperial College, Guy Scadding Building, Cale Street, London, SW3 6LY, UK. 7. Cardiology Department, University Hospital of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy. 8. Education Committee, European Society of Cardiology, Heart House. 2035 Route des Colles, 06903 Sophia-Antipolis, France. 9. Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, via Olgettina 60, 20132 Milano, Italy. 10. Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Preußenstraße 84, 41464 Neuss, Germany. 11. Department of Electrophysiology, University Leipzig - Heart Center, Strümpellstraße 39, 04289 Leipzig, Germany.
Abstract
Aims: To assess the knowledge and application of European Society of Cardiology (ESC) Guidelines in the management of mitral regurgitation (MR). Methods and results: A mixed-methods educational needs assessment was performed. Following a qualitative phase (interviews), an online survey was undertaken using three case scenarios (asymptomatic severe primary MR, symptomatic severe primary MR in the elderly, and severe secondary MR) in 115 primary care physicians (PCPs), and 439 cardiologists or cardiac surgeons from seven European countries. Systematic cardiac auscultation was performed by only 54% of clinicians in asymptomatic patients. Cardiologists appropriately interpreted echocardiographic assessment of mechanism and quantification of primary MR (≥75%), but only 44% recognized secondary MR as severe. In asymptomatic severe primary MR with an indication for surgery, 27% of PCPs did not refer the patient to a cardiologist and medical therapy was overused by 19% of cardiologists. In the elderly patient with severe symptomatic primary MR, 72% of cardiologists considered mitral intervention (transcatheter edge-to-edge valve repair in 72%). In severe symptomatic secondary MR, optimization of medical therapy was advised by only 51% of PCPs and 33% of cardiologists, and surgery considered in 30% of cases (transcatheter edge-to-edge repair in 64%). Conclusion: Systematic auscultation is underused by PCPs for the early detection of MR. Medical therapy is overused in primary MR and underused in secondary MR. Indications for interventions are appropriate in most patients with primary MR, but are unexpectedly frequent for secondary MR. These gaps identify important targets for future educational programs.
Aims: To assess the knowledge and application of European Society of Cardiology (ESC) Guidelines in the management of mitral regurgitation (MR). Methods and results: A mixed-methods educational needs assessment was performed. Following a qualitative phase (interviews), an online survey was undertaken using three case scenarios (asymptomatic severe primary MR, symptomatic severe primary MR in the elderly, and severe secondary MR) in 115 primary care physicians (PCPs), and 439 cardiologists or cardiac surgeons from seven European countries. Systematic cardiac auscultation was performed by only 54% of clinicians in asymptomatic patients. Cardiologists appropriately interpreted echocardiographic assessment of mechanism and quantification of primary MR (≥75%), but only 44% recognized secondary MR as severe. In asymptomatic severe primary MR with an indication for surgery, 27% of PCPs did not refer the patient to a cardiologist and medical therapy was overused by 19% of cardiologists. In the elderly patient with severe symptomatic primary MR, 72% of cardiologists considered mitral intervention (transcatheter edge-to-edge valve repair in 72%). In severe symptomatic secondary MR, optimization of medical therapy was advised by only 51% of PCPs and 33% of cardiologists, and surgery considered in 30% of cases (transcatheter edge-to-edge repair in 64%). Conclusion: Systematic auscultation is underused by PCPs for the early detection of MR. Medical therapy is overused in primary MR and underused in secondary MR. Indications for interventions are appropriate in most patients with primary MR, but are unexpectedly frequent for secondary MR. These gaps identify important targets for future educational programs.
Authors: Andrew J S Coats; Stefan D Anker; Andreas Baumbach; Ottavio Alfieri; Ralph Stephan von Bardeleben; Johann Bauersachs; Jeroen J Bax; Serge Boveda; Jelena Čelutkienė; John G Cleland; Nikolaos Dagres; Thomas Deneke; Dimitrios Farmakis; Gerasimos Filippatos; Jörg Hausleiter; Gerhard Hindricks; Ewa A Jankowska; Mitja Lainscak; Christoph Leclercq; Lars H Lund; Theresa McDonagh; Mandeep R Mehra; Marco Metra; Nathan Mewton; Christian Mueller; Wilfried Mullens; Claudio Muneretto; Jean-Francois Obadia; Piotr Ponikowski; Fabien Praz; Volker Rudolph; Frank Ruschitzka; Alec Vahanian; Stephan Windecker; Jose Luis Zamorano; Thor Edvardsen; Hein Heidbuchel; Petar M Seferovic; Bernard Prendergast Journal: Eur Heart J Date: 2021-03-18 Impact factor: 29.983
Authors: David Messika-Zeitoun; Pascal Candolfi; Maurice Enriquez-Sarano; Ian G Burwash; Vincent Chan; Jean-Francois Philippon; Jean-Manuel Toussaint; Partrick Verta; Ted E Feldman; Bernard Iung; David Glineur; Jean-Francois Obadia; Alec Vahanian; Thierry Mesana Journal: Open Heart Date: 2020-08
Authors: Francesco Giallauria; Anna Di Lorenzo; Alessandro Parlato; Crescenzo Testa; Emanuele Bobbio; Carlo Vigorito; Andrew J Stewart Coats Journal: ESC Heart Fail Date: 2020-12