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Valvular Heart Disease Care in Pakistan: Impact of the Multidisciplinary Valve Heart Team
Sabha Bhatti1, Samir Rehman1, Muhammad Usman1
1Department of Cardiovascular imaging & Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
Insights
A multidisciplinary heart team (HT) in Pakistan optimized valvular heart disease (VHD) patient care. The HT reclassified management for 24% of patients, recommending alternatives to surgery, improving VHD treatment strategies.
Area of Science:
- Cardiology
- Cardiac Surgery
- Public Health
Background:
- Complex valvular heart disease (VHD) management requires a multidisciplinary heart team (HT).
- Referral practices in low- and middle-income countries (LMICs) can bypass expert cardiac evaluation.
- This study addresses VHD patient demographics and HT impact in an LMIC setting.
Purpose of the Study:
- To analyze VHD patient demographics at a major heart valve center in an LMIC.
- To evaluate the influence of a multidisciplinary HT on surgical referrals for VHD.
- To assess the effectiveness of tailored treatment plans for VHD.
Main Methods:
- Prospective study of 2,003 VHD patients over 20 months in Karachi, Pakistan.
- All patients referred to an outpatient cardiovascular surgery clinic were assessed by a multidisciplinary HT.
- Individualized treatment plans were developed for each patient by the HT.
Main Results:
- Rheumatic heart disease and bicuspid aortic valve were leading causes of mitral and aortic stenosis, respectively.
- Of 2,003 patients referred for surgery, 76% were deemed suitable, 17% recommended for medical therapy, and 7% for transcatheter treatments.
- The HT altered management strategies for 24% of patients initially referred for surgery.
Conclusions:
- Multidisciplinary HTs enable individualized VHD treatment strategies.
- Collaborative decision-making leads to optimized patient management, including non-surgical options.
- HT integration improves care pathways for valvular heart disease in LMICs.
Background:
Patients with complex valvular heart disease (VHD) should be evaluated by a multidisciplinary heart team (HT). In low- and middle-income countries, referral practices are more variable, permitting any physician to refer patients directly to a cardiac surgeon without prior formal evaluation by a cardiologist with expertise in VHD.
Objectives:
The goal of the study was to examine the demographics of VHD patients seen in a large heart valve center in a low- and middle-income country and to assess the impact of the multidisciplinary HT in patients referred for valve surgery.
Methods:
Over a 20-month period, all patients with VHD seen in the National Institute of Cardiovascular Diseases (Karachi, Pakistan) outpatient cardiovascular surgery clinic were referred to the heart valve center and assessed by a multidisciplinary HT. The multidisciplinary HT developed individualized plans for each patient.
Results:
A total of 2,003 patients (52.8% female, mean age: 43.9 ± 14.4 years) were enrolled. Rheumatic heart disease was identified as the predominant cause of mitral valve disease, whereas bicuspid valve was the most common cause of significant aortic stenosis. All patients had been referred for valve surgery. Based on the HT's evaluation, 1,521 patients (76%) were deemed suitable for surgery, 335 patients (17%) were recommended for medical therapy, and 147 patients (7%) were considered candidates for transcatheter treatments. Notably, the HT reclassified the management strategies for 24% of the patients, all of whom had initially been referred for surgical intervention.
Conclusions:
The integration of collaborative decision-making through a multidisciplinary HT led to individualized and tailored treatment strategies, with a significant proportion of patients receiving alternative interventions or medical management instead of surgery.
