A new survey of 12,820 over 60s across Europe indicates that low levels of awareness of heart valve disease may prevent elderly people from seeking diagnosis and treatment.[ 1 ] The results from the survey, published in Clinical Research in Cardiology, coincide with the first ever European Heart Valve Disease Awareness Day taking place in six countries on 8 September 2018. The campaign calls for action to improve awareness, early diagnosis and treatment across Europe.
The findings, which consider the results alongside those of an awareness survey conducted two years ago, indicate more people are familiar with heart valve disease in general yet, alarmingly, understanding of aortic stenosis, the most common form of heart valve disease affecting between 2-7% of people over the age of 65 has decreased. Only 3.8% of survey respondents could correctly identify this form of heart valve disease compared to 7.21% in 2015.[ 1 ] In addition, almost two fifths of respondents (38.1%) were unaware of treatment options for heart valve disease.[ 1 ] This is despite the fact that approximately 2.7 million people over 65 years of age are thought to suffer from aortic stenosis in Europe, a number only set to increase due to Europe's ageing population.[ 2 ]
As levels of understanding remain low, so too do levels of concern for heart valve disease among Europeans. Despite a slight increase over the last two years (2015:1.7% vs 2017:2.1%), levels of concern are particularly low when compared to cancer (28.8%) or Alzheimer´s disease (20.9%).[ 1 ] This is despite annual mortality of severe aortic stenosis being considerably higher than most cancers.[ 3 ] , [ 4 ] This lack of understanding and concern for heart valve disease may prevent elderly people from seeking diagnosis and treatment.
"Results from this awareness study shows superficial knowledge of heart valve disease has increased but surprisingly people are still not sufficiently informed about heart valve disease and therefore show little concern for the condition," Professor Helge Möllmann, lead author and Cardiologist, St.-Johannes-Hospital, Dortmund, Germany comments. "Treating heart valve disease can return people to a good quality of life and normal life expectancy, so it is extremely important to educate and inform people on the condition."
Heart valve disease is a common, but treatable, heart condition where the heart valves no longer work properly. When the valves are diseased it can rapidly affect the pumping action of blood around the body. Symptoms of heart valve disease include chest pain, fatigue, shortness of breath, difficulty exercising and fainting and it can lead to sudden death. However, many patients do not suffer severe or visible symptoms, or put their symptoms down to the natural ageing process, making diagnosis difficult.[ 6 ] It is important to diagnose early as, if severe aortic stenosis is left untreated, half of those patients will die within two years of developing symptoms.
The survey revealed that respondents are most likely to report chest pain followed by chest tightness but nearly a fifth of respondents (19.8%) were unlikely to mention shortness of breath to their GP despite it being a common symptom of heart valve disease.[ 1 ]
Results indicate there continues to be discrepancy between the regularity with which men and women have stethoscope checks, with only 24.06% of women having their heart checked at every visit compared to (30.2%) of males.[ 1 ] This puts women at higher risk of receiving a late diagnosis as using a stethoscope to listen for a characteristic heart 'murmur' is the first step to identifying a problem with the heart valves.
Additionally, the survey found that stethoscope use, although improved in recent years, remains infrequent. Fewer people now rarely or never undergo auscultation (2015: 54.2% vs. 2017: 50.6%, p<0.001) and more Europeans currently have their hearts listened to by a doctor at every visit than two years previously (2015:24.2% vs. 2017:27.2%; p<0.001) However, the majority (54.1%) of people aged 60 or older are still not checked regularly.[ 1 ]
"The population itself must be aware of heart valve disease in order to initiate the first step in effective diagnosis - noticing symptoms," commented Professor Helge Möllmann. "The 8thSeptember 2018, is a monumental dayas it marks the first ever European Heart Valve Disease Awareness Day, a day focused on four key aspects to improve diagnosis and access to treatment across Europe. The results of this survey clearly showimportance ofhaving a day dedicated to improving understanding of heart valve disease and also highlight the urgent need for doctors to keep using their stethoscope, which is the key to diagnosis."
Encouragingly, although there is relatively low awareness and understanding of heart valve disease and potential treatment options, after receiving more information about the condition, survey respondents cited heart valve disease as a condition they wish to be checked for. Blood pressure was the condition most respondents wanted to be checked for regularly by GPs, with heart valve disease coming in a close second.[ 1 ]
There is an urgent need for improved awareness of heart valve disease and its effective treatments amongst patients and doctors in order to ensure a fully informed population who understand their symptoms and report them to their doctor. The primary treatment is heart valve replacement, either via open-heart surgery or a minimally invasive procedure such as a Transcatheter Aortic Valve Implantation (TAVI). Treatment can alleviate symptoms, prolong a patient's life span and improve health and quality of life.
Using a stethoscope to listen to the heart is one of the simplest steps that doctors can take towards diagnosis. Implementing regular heart health checks for heart valve disease after the age of 65 would increase regular stethoscope checks, thereby supporting early diagnosis of heart valve disease, which is key to improving outcomes.
About Heart Valve Disease
Heart valve disease is the name given to any malfunction or abnormality of one or more of the heart's four valves, affecting the blood flow through the heart. The condition is usually caused by wear, disease or damage of the heart valve(s).
About Aortic Stenosis
Aortic stenosis, a form of heart valve disease, is most often due to age-related degeneration or hardening (calcification) of the aortic valve, leading to progressive narrowing (stenosis) - changes which compromise valve function and impair normal blood flow through the heart.
About the Survey
In 2015, a heart health awareness survey was conducted amongst people over 60 years old across Europe. The surveys aimed to assess levels of awareness and concern regarding heart valve disease amongst the general population over 60. The latest survey aimed to evaluate whether awareness and knowledge among the general over 60s population regarding different diseases, including heart valve disease has changed and questioned 12,820 people over the age of 60 across 11 European countries, including France, Germany, Italy, Spain, Denmark, Netherlands, Sweden, Finland, Norway, Ireland and the UK. The survey was funded by Edwards Lifesciences.
About European Heart Valve Disease Awareness Day
The first European Heart Valve Disease Awareness Day takes place on the 8 September 2018 and has as it's theme 'The Power of Positive Ageing' which aims to improve diagnosis, treatment and management of heart valve disease in Europe. It seeks to do this via its '4A Action Plan' which calls for improved awareness, the implementation of annual stethoscope checks, national heart valve disease guidelines and equal access to treatments. The project is supported by a group of European patient societies including; Alliance du Cœur in France, Cuore Italia in Italy, Heart Valve Voice in the UK, AEPOVAC in Spain, Croi from Ireland, and Hart Volgers in the Netherlands. For more information, please visit: https://heartvalveday.eu/
1. Möllmann, H & Gaede, L et al. Heart Valve Disease Awareness Survey 2017: what did we achieve since 2015? Clinical Research in Cardiology. June 2018. https://doi.org/10.1007/s00392-018-1312-5
2. (US data) Go AS, et al; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation.2014;129:e28-e292; Stewart BF, et al. Clinical factors associated with calcific Aortic Valve Disease. Cardiovascular Health Study. J Am Coll Cardiol. Mar 1 1997;29(3):630-634; Nkomo V et al. Burden of valvular heart disease: a population-based study. Lancet. 2006;368:1005-11
(Numbers extrapolated to the EU based on over 65s population of 133, 587, 927 in 2017: https://www.populationpyramid.net/europe/2017/)
3. National Cancer Institute. SEER Cancer Stat Fact Sheets. Seercancergov. Available at: http://seer.cancer.gov/statfacts/. Accessed 23 March 2016
4. New Heart Valve. Aortic Stenosis Facts: Data on file, Edwards Lifesciences LLC. Analysis courtesy of Murat Tuczu, MD, Cleveland Clinic. Available at: https://newheartvalve.com/hcp/about-aortic-stenosis/ Accessed June 2018
5. Spaccarotella C et al. Pathophysiology of aortic stenosis and approach to treatment with percutaneous valve implantation. Circulation Journal. 2011;75:11-19
6. Bupa Heart Valve Disease Information Available at https://www.bupa.co.uk/health-information%20/directory/h/heart-valve-disease Accessed June 2018
7. Leon M, Smith C, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-1607
8. Heart Valve Voice, Diagnosis of Heart Valve Disease. Available at https://www.heartvalvevoice.com/heart-valve-disease/diagnosis Accessed June 2018
9. Heart Valve Voice. Giving a voice to those with Heart Valve Disease. A Heart Valve Voice White Paper. 2015. Available at: https://www.heartvalvevoice.com/application/files/6714/6005/9042/White_paper.pdf Accessed June 2018
10. British Heart Foundation: Heart Valve Disease. Available at: https://www.bhf.org.uk/heart-health/conditions/heart-valve-disease. Accessed September 2017
11. Patient.co.uk. Available at: http://patient.info/health/aortic-stenosis-leaflet. Accessed September 2017