UK “lags persistently behind” the rest of Europe in its management of structural heart disease


A multidisciplinary group of cardiac surgeons and interventional cardiologists, Heart Valve Voice, have launched a White Paper (Giving a voice to those with heart valve disease) to call for improved care of patients with structural heart disease in the UK. The group claim that the UK is “persistently lagging behind” the rest of Europe in the number of aortic valve replacements and transcatheter aortic valve implantation (TAVI) procedures it performs and state that at least 30% of patients with severe aortic stenosis are left untreated.

Heart Valve Voice report in the White Paper (which was supported by funding from Edwards Lifesciences) that during 2010/2011, France performed “more than double” the rate of aortic valve replacement procedures than the UK—283 per millions vs. 137 per million. They add: “The UK was also behind Germany (311 per million) and Belgium (283 per million) during the same period. According to the group, the UK’s use of TAVI “also lags behind” that of other countries. “In 2013, England’s TAVI rate was at 16 per million while France was at 57 per million,” the group note.

Another issue in the management of structural heart disease in the UK, the group state, is that there was a “persistent treatment gap” as evidence suggests that “at least 30% of those with severe forms of heart valve disease are left untreated”. They comment: “Data from Plymouth and Exeter illustrate low levels of referral; 54% of patients were not referred to the cardiac surgeon between July 2012 and July 2013, despite having heart valve disease confirmed by echocardiography. Those not referred were older (average of 86 years) than those referred to a surgeon (average of 76 years). Less than 20% of new admissions for aortic stenosis received an aortic valve replacement within six months of admission between 2002 and 2012.”

To address these and other issues, Heart Valve Voice are now calling for—in the White paper—“greater priority to be placed on heart valve disease accompanied by increased investment in providing curative valve repair and replacement” for patients with structural heart disease. To achieve these goals, they want an awareness campaign for healthcare professionals (and potential patients) on the symptoms of valve disease and the importance of early diagnosis and treatment, appropriate referral and follow-up between primary, secondary and tertiary care with a key role played by a multidisciplinary team to inform treatment decisions in partnership with patients, and the same level of surgical and transcatheter valve treatments as other leading European countries.

Ben Bridgewater, Heart Valve Voice chair and consultant cardiac surgeon, University Hospital of South Manchester, says: “We have an ageing population in the UK and the number of people with heart valve disease is set to increase. However, reversing the condition with valve replacement is eminently possible and can have a significant impact, greatly improving and lengthening the lives of those with the disease. It is unacceptable that when effective treatments for heart valve disease are available all patients in the UK do not receive timely diagnosis, effective referral and equal access to such treatment.”