‘Forgotten cousin’ of heart disease

More awareness is needed among GPs and their patients about the need to listen to the heart to detect heart valve disease, according to WA experts.

It follows local expertise in managing HVD being showcased at the American College of Cardiology Congress by consultant cardiologist and head of cardiology at the University of Notre Dame, Professor David Playford, who presented new data from an extensive Australian population survey. 

 His colleague, Dr Abdul Ihdayhid, an interventional cardiologist and cardiac CT specialist at Fiona Stanley Hospital and Harry Perkins Institute of Medical Research, spoke with Medical Forum about the key findings and the need to raise awareness about the risks of HVD. 

 “We wanted to better understand patients’ perspectives of primary care practice about their knowledge and assessment for HVD – which is the forgotten cousin in heart disease. There is a lot of focus on coronary artery disease and heart attacks, but valves are the forgotten, yet just as crucially important, structures of the heart,” Dr Ihdayhid said. 

 “Professor Playford has put forward some substantial numbers: there are more than a quarter of a million of Australians unaware they are living with HVD, which is projected to increase to 435,000 or nearly half a million people by 2050. 

 “But alarmingly, the key finding in our study was that despite a growing number of patients with HVD, the actual understanding of the disease, and awareness and concern among patients is incredibly low.” 

 Only 14% of the 1041 Australians aged 60+ years who participated in the survey rated HVD as a major health condition, while more than two in five reporting that their GP either ‘rarely’ or ‘never’ listened to their heart to perform a heart health check. 

 “Another key finding was that not a lot of people were getting auscultated by their primary care physicians, even though it used to be a standard part of nearly every consultation,” Dr Ihdayhid said. 

 “Things have changed, and that stethoscope is often just worn around our necks now as a medical fashion accessory. But auscultation is actually the front line of valvular heart disease and picking up that murmur is where the patient’s journey often begins – usually followed by an ultrasound of the heart and a visit to a cardiologist.” 

 Dr Ihdayhid said that one of the interesting findings was that patients did not have a great awareness of the different treatment options either.  

 Traditionally, most people thought they would need open heart surgery but in the last 10 years there had been a dramatic change in the way that valvular heart disease was treated — to now being treated minimally invasively (percutaneously) with transcatheter aortic valve replacement, where doctors could go through the artery of the leg and replace it in an hour. 

 “Patients can go home the next day if they have a narrowed aortic heart valve requiring aortic stenosis,” he said. “We can also fix leaking heart valves now using a Mitra clip to reduce the volume of leakage, then repeating that process in a couple of hours. And again, patients can go home the next day. 

 “It has dramatically changed the options for patients, particularly for elderly people who are never going to meet the criteria for open heart surgery. But what we found was that only 17% of patients knew there was a minimally invasive technology.” 

 Dr Ihdayhid said that the key message to the public was to ask them to go to their GP and get their heart listened to — nothing invasive, no blood tests and no pain. 

 “And from there, it is a straightforward conversation: ‘Actually, do you know that you have a narrowed heart valve? I do not need to do anything about it now, and we probably don’t even need to do anything about it for the next five years. But every couple of years, we need to keep an eye on it. 

 “Obviously, there will be a larger element of diagnosis, but at the GP level patients could present as a bit more breathless than normal or they might even feel nothing, which is why we are so reliant on routine auscultation. 

“We have recommended that everyone above the age of 60 should be getting regular heart health checks, and part of that really should include getting your heart listened to — something that every GP should be confident in doing — you just have to be able to identify a murmur.  

“The catchphrase is that it is ‘the silent disease you can hear.’ Most patients do not develop symptoms until right at the end of their disease and identifying the actual type of pathology is not as crucial now because we have such readily available echocardiography, and that is where the gold standard diagnosis is made. 

“But you could have heard HVD all along had you just put the stethoscope on their chest.”