Tuesday, 16 September 2014

Required - a National Framework for Heart Valve Disease.

The National Service Framework for Coronary Disease, published in March 2000, transformed the management of patients with coronary disease in the United Kingdom.
The newly elected Labour government with health secretaries Frank Dobson and (soon after) Alan Milburn had introduced a culture change to the UK National Health Service  - the concept of expert led, protocol driven, and well funded bodies that would drive improvement in healthcare from the top. These bodies included NICE and the precursor of the CQC  - the commission for health improvement or CHiMP. Accompanying these new bodies were the necessary appointment of 'top docs' or health Tsars. The newly appointed Heart Tsar was Dr. Roger Boyle. His Opus Magnus was the aforementioned NSF for Coronary Disease.
The NSF and what followed later in primary and public health with successful antismoking interventions, Statin prescribing and in specialst care with the setting up of Heart Attack centres has made the UK the best place in the world for the managemnt of patients with coronary disease.
The same cannot be said however for patients with heart valve disease.  Disorders of the heart valves may not be as prevalent as those affecting coronary arteries (which incidentally is on the wane) but as a(nother) disease of ageing, heart valve disease is rapidly becoming more common.  A degree of aortic valve stenosis is found in one tenth of all people in their 80s - a rapidly expanding demographic. Diagnosing significant heart valve disease is probably easier than diagnosing coroanry disease. All you need is a medical history and a stethoscope (and an echo machine). A heart valve National Service framework would increase awareness of the symptoms of heart valve disease amongst patients and primary care physicians and provide the funding for a big expansion in echocardiographic services that is urgently required in the English NHS. It would also provide some sensible direction to the planning of the management of these patients - i.e. cardiac surgery or the newer (very expensive) catheter based devices. It should, in conjunction with the National Institute of Health Research, commission urgently required research into the science of the commonest of the diseases affecting the population - aortic valve stenosis and mitral valve regurgitation.
In recent years a new British Heart Valve Society has been set up. (declaration of interest as treasurer). Members are predominantly professionals - cardiologists and cardiac surgeons interested in the management of patients with heart valve disease.
Heart Valve Voice is a new (industry backed) body of experts and patients whose main aim is to increase awareness of heart valve disease and to lobby politicians. They have produced this excellent infographic showing the results of a small but targeted  Europe wide survey. The results are eye-opening and confirm the need for such a venture.