Specialised heart valve clinics result in greater adherence to guideline-directed care: a comparative study

INTRODUCTION: International guidelines emphasise the role of heart valve centres (HVC) and specialist heart valve clinics (SHVC) to deliver optimal care to patients with heart valve disease (HVD). We sought to determine whether we could reaffirm the importance of SHVCs in our centre. METHODS: A total of 3731 consecutive non-SHVC (N-SHVC) patients were reviewed over 18 months. Patients (134) with a primary diagnosis of HVD were compared with 173 consecutive SHVC attendees based on international guidelines. Concordance was defined as adherence to recommended frequency of follow-up, investigations, timing of surgery and valve care advice, and discordance as any deviation from this. RESULTS: Of 134 N-SHVC patients (4.5%) with HVD, 89 (66.4%) had native valve disease and 45 (33.6%) prior heart valve surgery compared with 123 (71.1%) and 50 (28.9%) of SHVC patients, respectively, in the SHVC cohort. In symptomatic patients, the relationship to HVD was not documented in 31.5% of N-SHVC patients versus 5.7% of SHVC patients (p<0.001). Exercise testing was used infrequently in N-SHVCs compared with SHVCs (3.4% vs 32%, p<0.001) and surgical referral was lower (3.4% vs 26.8%, p<0.001). No N-SHVC patients with prior valve surgery received endocarditis prevention advice compared with 100% of SHVC patients. Overall, 34 (38.2%) of N-SHVC patients with native valve disease and 34 (84.4%) with prior cardiac surgery had discordant management compared with 4 (3.3%) and 2 (4%) of SHVC patients respectively. CONCLUSION: Almost 5% of patients with valve disease are still seen in an N-SHVC setting despite the availability of an SHVC within the same institute and receive suboptimal care.