Valvular heart disease rising rapidly, says report

Rates of valvular heart disease that could lead to serious complications are rising rapidly, according to Australian cardiovascular experts.

A new whitepaper, Our Hidden Ageing — Time to Listen to the Heart, developed by experts at the Baker Heart and Diabetes Institute, shows more than half a million Australians have valvular heart disease, including narrowing (stenosis) and leaking (regurgitation).

Perhaps more concerning, is that more than a quarter of a million Australians have faulty heart valves and are at risk of serious complications, and don’t know it. These complications include heart failure, stroke, blood clots, heart rhythm abnormalities, and even death.

Undiagnosed cases of valvular heart disease are projected to spiral over the next three decades, to 336,000 cases in 2031 and 435,000 in 2051, placing a heavy burden on our nation’s healthcare system, ageing population and economy.

Cardiologist, researcher and whitepaper lead author Professor Tom Marwick said, “Ageing causes the blood vessels to progressively lose elasticity and become stiff, impacting the vascular structure and function. This arterial damage increases mechanical stress on the valves, which are also susceptible to the same threats.

“A heart murmur is often the first symptom of heart valve disease,” Professor Marwick said.

“It is important to keep in mind that the common symptoms of heart valve disease — especially exercise intolerance — are often misattributed to ‘old age’.”

While there are four main causes of valvular heart disease — including a congenital defect, family history, and infection or inflammation — degenerative heart disease far exceeds the other causes.

Aortic valve disease is the most frequent cause of severe valvular heart disease. Its most common manifestation is aortic stenosis — a moderate-to-severe narrowing of the aortic valve. Cases of aortic stenosis are predicted to climb to 200,000 in 2031 and 266,000 in 2051.

Although serious, Professor Marwick said valvular heart disease is increasingly treatable.

Previously, people living with aortic stenosis had few options to replace their unhealthy aortic valve, including open heart surgery. These days however, aortic stenosis is the most treatable valve lesion due to the development of non-surgical valve replacement, such as transcatheter aortic valve implantation (TAVI).

Professor Marwick and cardiovascular experts nationwide are calling on the federal government to help address the nation’s rising rate of undiagnosed valvular heart disease.

“We need increased awareness through marketing campaigns; strategies to upskill and support primary care; financial support for the use of emerging technologies; health service design, including improved access to echocardiography; funding to improve access and equity to interventions; and development of national heart valve disease guidelines,” he said.

“Heightened awareness and education is critical to ensuring older Australians are aware of this disease, and to adequately support GPs to identify people at risk, and provide appropriate treatment before they develop a major cardiovascular problem.”

Professor Marwick says performing a thorough physical examination of the cardiovascular system, including auscultation, should form part of an annual GP check-up for every Australian over 65 years of age.

“Any abnormalities should then be further examined via echocardiography — the test of choice for valvular heart disease. Doctors should also take advantage of innovations in detection, diagnosis and treatment of valvular heart disease. The use of the digital stethoscope and handheld ultrasound may vastly improve the detection of valvular heart disease in the community,” he said.

“We must all keep in mind that valvular heart disease can go unrecognised, undiagnosed, and untreated, and the complications can be devastating.”

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