Operationalizing the 2014 ACC/AHA Guidelines for Valvular Heart Disease: A Guide for Clinicians

The 2014 American College of Cardiology/American Heart Association guidelines for valvular heart disease were released to help guide the clinician in caring for patients with this ever more prevalent and complex group of diseases and have been instrumental in providing a foundation of knowledge for the management of patients with valvular heart disease. However, there are many caveats in applying the guidelines to individual patients. As clinicians, we wish to outline important aspects to be considered by other clinicians, including the integration of the echocardiogram with the history and physical examination, recognition of discordant data within an echocardiographic examination, and proper interpretation of the cutoff measurements applied to timing of intervention. Decisions regarding management should be individualized to the institution, particularly when recommending early operation for an asymptomatic patient. Finally, all decisions should be individualized to each patient by not only recognizing specific comorbidities, but also understanding the patient's needs and preferences.