Year: 2023
Type: conference-paper
Study design: Observational Study
Abstract: Introduction Echocardiography is a quintessential tool to diagnose and monitor the progression of valvular heart disease. Recent guidelines from the BSE/BHVS/ESC/EACTS committees have established the benchmark for optimal surveillance timing of these patients. The surveillance process, whilst resource-intense, allows appropriate and timely escalation for valve intervention. Purpose A physiologist-led valve surveillance clinic was set up in a district general hospital to ensure patients with valvular heart disease would be monitored and followed up appropriately. An audit was performed to identify the challenges associated with meeting gold-standard target surveillance timing and best practice management in the outpatient setting. Method Retrospective data was pooled from all patients who were referred to the valve surveillance clinic in a 2 month period between February and March 2021. The data comprised of the severity of valve disease and symptom correlation, documentation of haemodynamic parameters and medications, as well as the follow up plan and escalation status of these patients. Results Out of 172 patients, 130 were guideline compliant with the appropriate surveillance interval. The remainder of these patients (24%) were recalled to surveillance at a much shorter time interval. The patient-cohort with the earlier recall tend to be the group with aortic valve pathologies (38% had severe aortic stenosis, 12% with mixed aortic valve disease) or valve replacements (21%). Further subgroup analysis of the asymptomatic, aortic stenosis group revealed that the mean follow up for severe cases was 3 months, instead of the recommended 6-month period, and moderate cases had a mean follow up of 11.1 months instead of the recommended time interval between 12-24 months, depending on the peak velocity across the valve. In cases pertaining severe asymptomatic, valve disease, it was noted that earlier recalls to clinic for assessment of progression of peak velocity and patient symptoms, did not alter the outcome and timing of referral to surgery. Secondary data such as symptom correlation and medication were well documented by the physiologists, but only half of the patients had their blood pressure documented. This had an additional bearing on the valve lesions as the severity can be influenced by loading conditions and blood pressure control. Conclusion and Follow Up Recalls to surveillance clinic, which were earlier than the recommended valvular disease guidelines, did not impact the overall referral and management of patients, and only added workload to the cardiology department. Members of the valve surveillance clinic were given guidance and a printed worksheet, incorporating the recommended surveillance schedule for each valvular lesion, to ensure optimal triaging and timely follow up would take place. This aims to improve resource allocation and outpatient management of patients with valvular heart disease. References 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). (2022). European Heart Journal. British Heart Valve Society (2020). BHVS Blueprint. Conflict of Interest None
Source: Heart
Authors: Wei Jun How, Rosemarie Stringfellow, Kah Tong, Rosica Panayotova, Jack Hay
Institution: Stepping Hill Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4384568136