Atrioventricular valve regurgitation: still a long road ahead
19 Mar 2021-Heart (BMJ Publishing Group Ltd and British Cardiovascular Society)-Vol. 107, Iss: 12, pp 947-948
TL;DR: Cahill et al. as mentioned in this paper reported an analysis of the OxValve cohort assessing the prevalence, presentation and outcome of atrioventricular valve regurgitations, and the unadjusted prevalence of moderate or severe mitral or tricuspid regurgitation was estimated at 2.0% in subjects aged 65-75 years and 7.7% in those aged ≥75 years.
Abstract: In this issue of Heart , Cahill et al report an analysis of the OxValve cohort assessing the prevalence, presentation and outcome of atrioventricular valve regurgitations.1 The strength of the OxValve cohort is that it was prospectively designed to specifically study heart valve disease using systematic echocardiographic examination in an unselected population aged 65 years or more in a community setting. Echocardiography is the only means to reliably assess the prevalence of heart valve disease since auscultation correctly identifies only around 10% of patients with heart valve disease.2 Unbiased assessment of the prevalence and characteristics of patients with heart valve disease needs to be performed in a community setting, as illustrated by differences between the OxValve and the hospital database cohorts. Moreover, contemporary guideline-based criteria were used in the OxValve cohort for the quantification of the severity of regurgitations and the identification of their mechanisms. Such detailed analyses were not performed in the rare previous population-based studies on the epidemiology of heart valve disease. The collection of detailed and standardised echocardiographic data in a large population-based study is therefore highly relevant in the field of heart valve disease.
The unadjusted prevalence of moderate or severe mitral or tricuspid regurgitation was estimated at 2.0% in subjects aged 65–75 years and 7.7% in those aged ≥75 years. This considerable increase in the prevalence …
Citations
More filters
TL;DR: Otto et al. as discussed by the authors summarized the National Institute for Health and Care Excellence (NICE) principles and processes for development of clinical guidelines in England, and compared the NICE methodology with the current approach of our cardiovascular professional societies, as well as to established reporting criteria for clinical practice guidelines.
Abstract: Clinical guidelines have become a core element in optimising care for patients with cardiovascular disease. However, the quality of guidelines depends on a rigorous unbiased process that integrates the clinical evidence with input from a range of stakeholders. In this issue of Heart , Garbi1 summarises the National Institute for Health and Care Excellence (NICE) principles and processes for development of clinical guidelines in England. The discussion is divided into four key areas: (1) Guideline development by an independent advisory committee includes aligning recommendations with national health policies, and involvement of patients, patient-advocates, and the public as well as healthcare professionals. (2) Recommendations should be based on relevant, reliable and robust evidence and should include consideration of cost-effectiveness and population benefit. (3) Guidelines should support innovation and reduce healthcare inequalities. (4) Finally, ensuring guideline implementation and providing regular updates are essential.
In the accompanying editorial, Otto, Kudenchuk and Newby2 compare the NICE methodology with the current approach of our cardiovascular professional societies, as well as to established reporting criteria for clinical practice guidelines (figure 1).3 They propose several areas for improvement including cooperative development of a common evidence database; a rigorous transparent process based on established standards; a more diverse group of stakeholders; minimising conflicts of interest; support by information specialists, medical writers and other relevant experts; regular updates; adaptation for regional …
References
More filters
University of Paris1, Leiden University Medical Center2, Medical University of Vienna3, St Thomas' Hospital4, University of Cambridge5, Vita-Salute San Raffaele University6, Valve Corporation7, University of Rostock8, European Society of Cardiology9, Carol Davila University of Medicine and Pharmacy10, University of Zurich11, University of Bern12
TL;DR: 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.
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 EURObservati...
241 citations
TL;DR: An observational cohort study to assess the clinical characteristics, outcomes, and degree of undertreatment of mitral regurgitation in a community setting in Olmsted County, USA found that patients with a low comorbidity burden combined with favourable characteristics such as left-ventricular ejection fraction of 50% or higher incurred excess mortality.
235 citations
Institute for Health Metrics and Evaluation1, University of Limoges2, University College Hospital, Ibadan3, Obafemi Awolowo University4, Tehran University of Medical Sciences5, Mayo Clinic6, Cleveland Clinic7, Iran University of Medical Sciences8, Essentia Health9, Georgia Regents University10, Babol University of Medical Sciences11, Karolinska Institutet12, University of Porto13, University of Washington14, Federal University of Bahia15, Mazandaran University of Medical Sciences16, University of Louisville17, Kaiser Permanente18, A.T. Still University19, University of North Carolina at Chapel Hill20, Hamdan bin Mohammed e-University21, University of Ibadan22, Shahid Beheshti University of Medical Sciences and Health Services23, University of Tartu24, Medical Research Council25, University of Cape Town26, University of South Carolina27, KISA28, Metropolitan University29, Brown University30, University of Manitoba31, University of Virginia32, National Institutes of Health33, Kyrgyz State Medical Academy34, King Saud University35, Carol Davila University of Medicine and Pharmacy36, Duy Tan University37, Maimonides Medical Center38, University of Bern39, Imperial College London40, University College London41, Public Health England42, West Virginia University43, Ain Shams University44, Adigrat University45, Hanoi Medical University46, Gomal University47, Harvard University48, Guy's and St Thomas' NHS Foundation Trust49, King's College London50
TL;DR: These global and national estimates demonstrate that CAVD and degenerative mitral valve disease are important causes of disease burden among older adults, with highest age-standardized DALY rates of CAVD estimated for high-income countries.
Abstract: Background: Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence,...
171 citations
TL;DR: Tricuspid valve disease is mainly represented by tricuspid regurgitation, which is a predictor of poor outcome, and given the recent major breakthrough in the percutaneous treatment of aortic and mitral valve diseases, the tric Suspid valve appears an appealing challenge, although it raises specific issues.
34 citations