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Greater use of chest auscultation can increase early detection of heart valve disease

Greater use of chest auscultation can increase early detection of heart valve disease

Publication date: Wednesday, 06 December 2017
Contributor(s): Jeremy Bray

GPs can improve the early detection of heart valve disease by increasing use of chest auscultation when seeing older patients, UK primary care specialists have recommended.

“Heart failure is often the first presentation of aortic stenosis in primary care,” Dr Jarir Amarin, GP with a special interest in CVD, Carlton House Surgery, Enfield, told a briefing held during the recent PCR London Valves 2017 meeting (24-26 September). He suggested that earlier diagnosis of heart valve disease could increase treatment options and outcomes, particularly in older patients.

“Patients are often not forthcoming about symptoms of heart valve disease, which typically include shortness of breath on exertion and chest tightness,” he pointed out. This makes it important to ask about typical symptoms, distinguish between acute and chronic symptoms, and use chest auscultation. He noted that auscultation is currently used in fewer than 40% of patients whose symptoms suggest heart valve disease.

“Ideally we should use a stethoscope routinely for all patients over 65, including when they are having a flu vaccination and at NHS Health Checks,” he suggested. A heart murmur warrants further clinical examination and a non-urgent cardiology referral for patients with signs and symptoms but no recent deterioration, while those with exertional chest pain and/or palpitations should be referred urgently.

New guidelines from the European Society of Cardiology support expanding consideration of transcatheter aortic valve implantation (TAVI) for aortic stenosis to include intermediate-risk patients. “They favour the use of TAVI over surgery in elderly patients at increased surgical risk,” explained Professor Bernard Prendergast, consultant cardiologist at St Thomas’ Hospital, London.

He explained that the recommendations are based on randomised trials and registry data showing that TAVI is non-inferior to medical therapy in terms of mortality and superior when transfemoral access is possible in intermediate-risk patients. He hopes that NICE will review its current guideline limiting TAVI to high-risk patients to align with the recent ESC recommendations.

The briefing was supported by Edwards Lifesciences.

More information

Useful information on the management of heart valve disease is available from including Practical Guidance for Primary Care.
Topics covered:
Category: Have You Heard
Edition: Volume 2 Number 11 PCCJ Online 2017
Contributor(s): Jeremy Bray

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