Neil Johnson: Ageism and Outcomes for Heart Valve Disease

When it comes to cardiovascular health, ageism appears to present a significant barrier to the diagnosis and treatment of heart valve disease among older adults. Despite the substantial contribution this demographic makes to society, they are often overlooked or dismissed when presenting in primary care settings with symptoms commonly associated with ageing. Studies suggest that primary care providers sometimes fail to recognise or adequately investigate these symptoms in older adults from a cardiac perspective, often dismissing them as purely part of the ageing process and thus leading to missed or delayed diagnoses of valve disease. This oversight can not only compromise patient outcomes but can also exacerbate the burden on the healthcare system.

Chronic disease, of which cardiovascular disease (CVD) is the predominant contributor, is placing an enormous strain on healthcare systems globally. This burden is particularly acute in the over 50’s or ‘third age’. Despite this, there is a noticeable absence of clear or targeted strategies focused on the earlier detection and diagnosis of cardiovascular conditions within the ageing population. Consequently, this demographic finds itself at the coalface of healthcare overload, facing prolonged waiting lists and extended time delays in receiving care.

Our ageing population continue to make invaluable contributions to society, often well into the golden years, whether that’s through the provision of childcare while family members go to work or contributing to the work of civil society organisation to providing home care for a spouse or partner.  Yet, the health needs of this ageing population, particularly when it comes to heart valve disease, are not being met with the urgency and attention they deserve. This inequity not only undermines their quality of life but also diminishes their ability to continue to contribute to their families and society effectively.

Heart valve disease is a common and serious condition closely associated with ageing. Early diagnosis and timely access to treatment directly correlate with quality of life and healthy ageing. Proactive strategies to deliver early detection and timely treatment are central calls from organisations like Heart Valve Voice in the UK and the Global Heart Hub, which is a global coalition of patient organisations. Regular stethoscope checks followed by swift referral to a specialist for confirmation of diagnosis and then timely treatment intervention significantly improve outcomes for older patients. However, there is a prevailing approach of ‘watchful waiting,’ where patients are monitored over time without active management until the disease progresses to a more severe stage. This approach is not delivering for many patients. This passive strategy often results in many older adults being lost to the system or forgotten on waiting lists, resulting in the silent worsening of the disease when an earlier intervention would have been more beneficial. 

The concept of watchful waiting in the management of older valve patients can result in significant adverse outcomes. Without proactive management, these patients often experience a rapid decline in their health, leading to emergency situations that could have been prevented with earlier intervention. This not only affects patient outcomes but also places additional strain on health systems.

The intersection of ageism and heart valve disease presents a critical challenge that requires urgent attention and action. Life expectancy continues to increase in developed countries, and it is in the interest of the patient, the carer, the healthcare system and society in general for the ageing population to enjoy good health for as long as possible. The current healthcare approach to older adults, particularly in the context of cardiovascular health and heart valve disease, in particular, is inadequate. Heart Valve Voice UK and the Global Heart Hub are calling for the development and implementation of strategies focused on early detection and proactive management of heart valve disease in the ageing population. Such initiatives would not only improve health outcomes but would also reduce the burden on our already overburdened healthcare systems. Surely, we have an obligation to recognise the contribution of our older population matched with equity of commitment to their health and well-being. A Global Heart Hub position paper on Healthy Ageing, published in 2023, is a joint international patient community initiative aligned with the UN Decade of Healthy Ageing (2021-2030). The report called on policymakers, health system leaders, patients, caregivers, healthcare providers and other stakeholders to prioritise and strengthen the response to the growing burden of heart valve disease.

Neil Johnson – Executive Director of Global Heart Hub