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Specialised heart valve clinics result in greater adherence to guideline-directed care: a comparative study

Natalie Montarello1, Curtis Page2, Sophie Bennett2

  • 1Cardiovascular Directorate, Guy's and St Thomas' Hospitals NHS Trust, London, England, UK nataliemontarello@gmail.com.

Open Heart
|March 31, 2026
PubMed

Insights

Patients with heart valve disease (HVD) treated outside specialist heart valve clinics (SHVC) receive suboptimal care. This study highlights the critical importance of SHVCs for optimal HVD management and patient outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Health Services Research

Background:

  • International guidelines recommend specialist heart valve centres (HVC) and clinics (SHVC) for optimal heart valve disease (HVD) care.
  • This study aimed to validate the importance of SHVCs within our institution.

Purpose of the Study:

  • To compare the quality of care for HVD patients managed within a specialist heart valve clinic (SHVC) versus those managed in non-specialist settings (N-SHVC).
  • To assess adherence to international guidelines for HVD management, including follow-up, investigations, surgical timing, and valve care advice.

Main Methods:

  • Retrospective review of 3731 consecutive non-SHVC patients over 18 months.
  • Comparison of 134 HVD patients from N-SHVC settings with 173 consecutive SHVC attendees.
  • Concordance defined by adherence to recommended HVD care protocols; discordance by any deviation.

Main Results:

  • HVD patients in N-SHVC settings showed significant discordance in management (38.2% native valve, 84.4% prior surgery) compared to SHVC patients (3.3% native valve, 4% prior surgery).
  • N-SHVC patients had less documented symptomatic correlation to HVD (31.5% vs 5.7%), infrequent exercise testing (3.4% vs 32%), and lower surgical referral rates (3.4% vs 26.8%).
  • No N-SHVC patients with prior valve surgery received endocarditis prevention advice, unlike 100% of SHVC patients.

Conclusions:

  • A significant proportion of HVD patients (almost 5%) are managed in non-specialist settings, receiving suboptimal care despite SHVC availability.
  • This underscores the necessity of SHVCs for ensuring guideline-adherent and optimal management of heart valve disease.
  • Centralizing HVD care within SHVCs is crucial for improving patient outcomes and adherence to best practices.
Abstract

Keywords:
EchocardiographyHeart Valve DiseasesOutcome Assessment, Health Care

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