Valvular Heart Disease in the Community: A European Experience

https://doi.org/10.1016/j.cpcardiol.2007.07.002Get rights and content

Abstract

The Euro Heart Survey on valvular heart disease included 5001 patients from 92 centers in 25 European countries in 2001: 71.9% had native valve disease and 28.1% had previously undergone valve surgery. Aortic stenosis (AS) and mitral regurgitation (MR) accounted for 43.1 and 33.6%, respectively, of single-valve diseases and were mostly caused by degenerative diseases. Mean age was 69 and 65 years, respectively, and at least one comorbidity was present in 36.3% of patients with AS and 41.7% with MR. Analysis of the therapeutic decision in patients with severe valve diseases showed that symptomatic patients were frequently denied surgery (32.3% in AS after the age of 75 and 51.3% in MR), more on the basis of age and left ventricular function than comorbidities. There was a better concordance between practice and guidelines concerning interventions in asymptomatic patients. These findings underline the need for better implementation of guidelines.

Section snippets

Organization and Choice of Centers

The Scientific Expert Committee elaborated the study protocol, which was then validated by the Committee for Cardiovascular Databases, Registries, and Surveys of the European Society of Cardiology. National cardiac societies were asked to designate a coordinator who was responsible for the implementation of the protocol, helped translating relevant documents to get approval for the survey, and assisted in the selection of centers.

Tertiary and community centers were included, with or without

Overall Population

Ninety-two centers from 25 countries participated in the survey (Fig 1) and they included 5001 patients. There was a good balance between Western (1407 patients), Mediterranean (1444 patients), and Eastern Europe (1750 patients), while Northern Europe was underrepresented (400 patients). Of the 5001 patients, 1269 underwent a valvular intervention during the survey period in a center participating in the Euro Heart Survey. The type of intervention was stated in 1263 patients: 1099 were on a

Discussion

The Euro Heart Survey gives the opportunity to analyze contemporary characteristics and management of patients with valvular heart disease. The inclusion of patients in a wide range of health care structures throughout Europe enables current practices to be analyzed and compared with guidelines.

Conclusion

This contemporary European overview of patients with valvular heart disease who were managed in a variety of health care structures shows that degenerative etiologies are now by far the most frequent. As a consequence, the burden of valvular heart disease in the elderly is high, in particular in AS and MR, which are the two most frequent native valve diseases. This has important implications in decision-making since too many patients with severe symptomatic valve diseases are denied surgery,

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    The Euro Heart Survey on valvular heart disease was funded by the European Society of Cardiology, Dutch Heart Foundation, Fédération Française de Cardiologie/Société Française de Cardiologie, Hellenic Cardiological Society, Swedish Heart and Lung Foundation, European Commission Grant (Infermed/Mansev Project), and Toray Medical Company.

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