Key result
Australian veterinarians more accurately staged clinical Stage C canine MMVD than preclinical Stage B2, with only 47.3% recommending guideline-concordant Stage B2 treatment.
Why the study?
Little was known about how veterinarians in general practice in Australia utilise the updated ACVIM guidelines for canine myxomatous mitral valve disease, which newly recommend pimobendan for all dogs with Stage B2 disease.
Cross-Sectional (n=319)
Yes
While most Australian general practice veterinarians manage clinical canine MMVD in line with international guidelines, significant gaps exist in the diagnostic workup and accurate staging of preclinical Stage B2 patients, leading to under-treatment with pimobendan.
Answers are grounded in this paper and cite their sources.
Staging inaccuracies may cause under-treatment of preclinical canine MMVD; leaves open whether targeted education improves guideline concordance.
Background Canine myxomatous mitral valve disease (MMVD) is the most common heart disease of dogs, accounting for approximately 75% of canine heart disease cases. The latest iteration of the American College of Veterinary Internal Medicine (ACVIM) guidelines on this topic marked a significant change in management recommendations from a previous “watch and wait” approach for preclinical MMVD to recommending treatment with pimobendan for all dogs with Stage B2 MMVD. Little is currently known about the utilisation of these guidelines by veterinarians in general practice in Australia. The current study aimed to investigate the diagnosis, staging and management of MMVD by veterinarians in general practice in Australia utilising a series of four clinical vignettes, including their familiarity with, and accessibility to, various cardiology diagnostic techniques. Results The data from 319 valid responses were analysed. A significantly greater proportion of respondents correctly staged the clinical case as Stage C compared to preclinical vignettes. Regarding treatment of preclinical disease, only 47.3% of total respondents recommended treatment for Stage B2 disease in line with ACVIM recommendation. In managing Stage B2 disease, veterinarians were more likely to recommend treatment when the murmur was graded as high (72.4%) compared to mild (47.3%) for a similarly staged dog. Conclusions This survey demonstrated that whilst most veterinarians are making recommendations in line with accepted international guidelines for MMVD, there is scope to improve diagnostic, staging and treatment protocols in general practice in Australia, particularly in preclinical patients. Two main barriers to correctly stage, and therefore correctly treat, a preclinical patient were identified. Firstly, a significant proportion of veterinarians are opting to monitor asymptomatic patients with a heart murmur rather than recommending a diagnostic investigation and secondly, the ability to accurately stage preclinical patients according to the ACVIM guidelines once imaging has been performed.
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Perry et al. (2026) conducted a cross-sectional in Canine myxomatous mitral valve disease (MMVD) (n=319). Clinical vignette of clinical MMVD (Stage C) vs. Clinical vignettes of preclinical MMVD (Stage B1 and Stage B2) was evaluated on Correct staging of MMVD according to ACVIM guidelines (p=0.023). Australian veterinarians more accurately staged clinical Stage C canine MMVD than preclinical Stage B2, with only 47.3% recommending guideline-concordant Stage B2 treatment.
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