Professor Huon Gray CBE
Wednesday 14th February 2024
As a ‘mostly retired’ Cardiologist, I find myself reflecting on heart valve disease (HVD) and the changes related to it that have occurred over the past decade. Whilst well recognised by specialists for many decades, levels of awareness of HVD in the general population has been low, with detection and diagnosis often occurring late, making treatment less effective. However, I am pleased to see that awareness of these conditions is at last improving, and there is the prospect of more people who are currently undetected being diagnosed and referred for specialist care. There is still a long way to go, and far too many people are still living with heart valve conditions that are undiagnosed, but improvements in detection and particularly advances in treatment technologies, are changing the landscape, and it is welcome that the NHS has recognised this in its Long Term Plan (2019).
One of the challenges in increasing awareness of these conditions is the frequency with which symptoms related to heart valve disease are mistaken for other conditions. Those with HVD often present with non-specific symptoms, such as fatigue, reduction in exercise capacity, breathlessness and, in severe cases, loss of consciousness (syncope) on exercise. Frequently, symptoms are attributed to ageing or other common ailments, particularly lung disease. Conditions affecting the heart valves (usually narrowing or leakiness) often slip through the diagnostic cracks, leaving many suffering in silence. The situation demanded a shift in perspective, and I’m pleased to see that on various fronts this is being addressed.
Public service announcements and targeted educational programs are increasing the profile of HVD, such as the SLOW campaign by the charity Heart Valve Voice, which in many ways seeks to mirror the FAST campaign undertaken to increase awareness of stroke symptoms. Increasing public awareness has helped empower individuals to recognise their symptoms and has stimulated them to seek medical attention. This cultural shift has been instrumental in dismantling some of the barriers to early detection. Pilot studies have also suggested the potential for some diagnostic services being delivered by pharmacists using AI-enabled stethoscope technology. We await further evidence of its wider place in the delivery of services, but the field looks promising.
Echocardiography, once the primary tool for diagnosis, has been complemented by innovative modalities such as 3D echocardiography and cardiac magnetic resonance imaging (MRI). These advancements not only enhance our ability to detect valve abnormalities but also facilitate a more nuanced understanding of the disease's progression. In addition to the efforts being made to increase awareness and diagnosis, advances in technology now mean that many people who require treatment for HVD can have this undertaken by minimally invasive techniques, such as transcatheter aortic valve replacement (TAVI). Open heart surgery is still often required, but the less invasive, catheter-based techniques offer hope for those unsuitable for surgical treatment and, increasingly, as an alternative to surgery for many. The increasing availability of percutaneous therapies contributes to the shift towards care that is more personalised and patient-centric.
However, as we celebrate the progress made, we have to acknowledge the challenges that persist. Despite strides in awareness and technology, there remains a considerable portion of the population unaware of the risks and symptoms associated with heart valve disease. Bridging this knowledge gap requires sustained efforts in public and medical education, community engagement, and ensuring that individuals across all demographics are equipped with the information necessary for early intervention. We should not lose sight of the fact that while detection is improving, a significant proportion of heart valve disease in the UK remains undiagnosed.
The past decade is one where HVD has certainly received much greater attention, which is welcome. Credit is due to many clinicians, NHS leaders, and the drive of organisations such as Heart Valve Voice, the British Heart Foundation and the professional societies who strive to improve pathways of care and save lives. From the perspective of someone no longer in clinical practice, the outlook for those with HVD looks much brighter, whether that’s through increasing awareness or improvements in diagnostic techniques and treatment options. Long may this progress continue, for there is much left to be done. It should be the goal of all involved in healthcare to reduce avoidable deaths and ensure equity of access to early diagnosis and advances in specialist care. I commend all those whose commitment is to achieving this.
Professor Huon Gray CBE
Consultant Cardiologist Emeritus and
past National Clinical Director for Heart Disease, NHS England