Valvular heart disease: putting guidelines into practice

Letting symptoms guide management is no longer acceptable

Like many areas of medical care, the management of valvular heart disease has undergone a revolution within the practising lifetime of many doctors. As improved interventions have become available, so has the need to investigate correctly and identify better those who could benefit from such interventions. Recommendations for investigating and managing valvular heart disease have recently been published by Britain's Royal College of Physicians.1

Much of what we know about the natural course of valvular heart disease comes from an era before surgical intervention, when patients presenting with symptomatic disease were unlikely to survive more than five to 10 years.2 3 Few investigative tools were available and management decisions were based on the patient's symptoms. It has now become clear that symptoms alone are not an adequate guide, since the lack of symptoms does not predict an …