Bernard Iung1, Victoria Delgado2, Raphael Rosenhek3, Susanna Price4, Bernard Prendergast5, Olaf Wendler6, Michele De Bonis7, Christophe Tribouilloy8, Arturo Evangelista9, Alexander Bogachev-Prokophiev10, Astrid Apor11, Hüseyin Ince12, Cécile Laroche13, Bogdan A Popescu14, Luc Piérard15, Michael Haude16, Gerhard Hindricks17, Frank Ruschitzka18, Stephan Windecker19, Jeroen J Bax2, Aldo Maggioni13, Alec Vahanian20. 1. AP-HP, Cardiology Department, DHU Fire, Bichat Hospital, Université de Paris, Paris, France. 2. Department of Cardiology, Leiden University Medical Center, The Netherlands. 3. Department of Cardiology, Medical University of Vienna, Austria. 4. Unit of Critical Care, Royal Brompton & Harefield NHS Trust, London, United Kingdom. 5. Department of Cardiology, St Thomas' Hospital, London United Kingdom. 6. Department of Cardiothoracic Surgery, King's College Hospital, London, United Kingdom. 7. Vita-Salute San Raffaele University, Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Milan, Italy. 8. Department of Cardiology, University Hospital Amiens, France. 9. Department of Cardiology, Hospital Vall d'Hebron, Barcelona 08036, Spain. 10. Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation. 11. Heart and Vascular Center, 1122 Budapest, Hungary. 12. Department of Cardiology, Rostock University Medical Center, Rostock, Germany. 13. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France. 14. University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania. 15. Cardiology Department, University Hospital of Liege, Sart Tilman University Hospital Center, Liège, Belgium. 16. Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus, Neuss, Germany. 17. Department of Electrophysiology, University Leipzig - Heart Center, Leipzig, Germany. 18. Clinic of Cardiology, University Heart Centre, University Hospital, Zurich, Switzerland. 19. Cardiology Department, Bern University Hospital, Bern, Bern, Switzerland. 20. Université de Paris, Paris, France.
Abstract
Background: Valvular heart disease (VHD) is an important cause of mortality and morbidity and has been subject to important changes in management. The VHD II survey was designed by the EURObservational Research Programme of the European Society of Cardiology (ESC) to analyze actual management of VHD and compare practice with guidelines. Methods: Patients with severe native VHD or previous valvular intervention were enrolled prospectively across 28 countries over a 3-month period in 2017. Indications for intervention were considered concordant if the intervention was performed or scheduled in symptomatic patients, corresponding to Class I recommendations specified in the 2012 ESC and in the 2014 American Heart Association/American College of Cardiology VHD guidelines. Results: 7247 patients (4483 hospitalized, 2764 out-patients) were included in 222 centers. Median age was 71 years (interquartile range 62-80); 1917 patients (26.5%) were aged ≥80 years and 3416 were female (47.1%). Severe native VHD was present in 5219 patients (72.0%): aortic stenosis (AS) in 2152 patients (41.2% of native VHD), aortic regurgitation (AR) in 279 (5.3%), mitral stenosis (MS) in 234 (4.5%), mitral regurgitation (MR) in 1114 (21.3%, primary in 746 and secondary in 368) multiple left-sided VHD in 1297 (24.9%) and right-sided VHD in 143 (2.7%). 2028 patients (28.0%) had undergone previous valvular intervention. Intervention was performed in 37.0% and scheduled in 26.8% of patients with native VHD. The decision for intervention was concordant with Class I recommendations in symptomatic patients with severe single left-sided native VHD in 79.4% (95% confidence interval [CI] 77.1-81.6%) for AS, 77.6% (95% CI 69.9-84.0%) for AR, 68.5% (95% CI 60.8-75.4%) for MS, and 71.0% (95% CI 66.4-75.3%) for primary MR. Valvular interventions were performed in 2150 patients during the survey; of them, 47.8% of patients with single left-sided native VHD were in New York Heart Association class III or IV. Transcatheter procedures were performed in 38.7% of patients with AS and 16.7% of those with MR. Conclusions: Despite good concordance between Class I recommendations and practice in patients with aortic VHD, the suboptimal figure in mitral VHD and late referral for valvular interventions suggest the need to improve further guideline implementation.
Background: Valvular heart disease (VHD) is an important cause of mortality and morbidity and has been subject to important changes in management. The VHD II survey was designed by the EURObservational Research Programme of the European Society of Cardiology (ESC) to analyze actual management of VHD and compare practice with guidelines. Methods:Patients with severe native VHD or previous valvular intervention were enrolled prospectively across 28 countries over a 3-month period in 2017. Indications for intervention were considered concordant if the intervention was performed or scheduled in symptomatic patients, corresponding to Class I recommendations specified in the 2012 ESC and in the 2014 American Heart Association/American College of Cardiology VHD guidelines. Results: 7247 patients (4483 hospitalized, 2764 out-patients) were included in 222 centers. Median age was 71 years (interquartile range 62-80); 1917 patients (26.5%) were aged ≥80 years and 3416 were female (47.1%). Severe native VHD was present in 5219 patients (72.0%): aortic stenosis (AS) in 2152 patients (41.2% of native VHD), aortic regurgitation (AR) in 279 (5.3%), mitral stenosis (MS) in 234 (4.5%), mitral regurgitation (MR) in 1114 (21.3%, primary in 746 and secondary in 368) multiple left-sided VHD in 1297 (24.9%) and right-sided VHD in 143 (2.7%). 2028 patients (28.0%) had undergone previous valvular intervention. Intervention was performed in 37.0% and scheduled in 26.8% of patients with native VHD. The decision for intervention was concordant with Class I recommendations in symptomatic patients with severe single left-sided native VHD in 79.4% (95% confidence interval [CI] 77.1-81.6%) for AS, 77.6% (95% CI 69.9-84.0%) for AR, 68.5% (95% CI 60.8-75.4%) for MS, and 71.0% (95% CI 66.4-75.3%) for primary MR. Valvular interventions were performed in 2150 patients during the survey; of them, 47.8% of patients with single left-sided native VHD were in New York Heart Association class III or IV. Transcatheter procedures were performed in 38.7% of patients with AS and 16.7% of those with MR. Conclusions: Despite good concordance between Class I recommendations and practice in patients with aortic VHD, the suboptimal figure in mitral VHD and late referral for valvular interventions suggest the need to improve further guideline implementation.
Entities:
Keywords:
guidelines; transcatheter interventions; valvular heart disease; valvular surgery
Authors: Eduardo Pozo Osinalde; Alejandra Salinas Gallegos; Ximena Gordillo; Luis Nombela Franco; Pedro Marcos-Alberca; Patricia Mahía; Gabriela Tirado-Conte; José Juan Gómez de Diego; Pilar Jiménez Quevedo; Antonio Fernández-Ortíz; Julián Pérez-Villacastín; Jose Alberto de Agustín Loeches Journal: J Clin Med Date: 2022-04-19 Impact factor: 4.964
Authors: Sean Coffey; Ross Roberts-Thomson; Alex Brown; Jonathan Carapetis; Mao Chen; Maurice Enriquez-Sarano; Liesl Zühlke; Bernard D Prendergast Journal: Nat Rev Cardiol Date: 2021-06-25 Impact factor: 32.419