Oppor­tu­ni­ties for improv­ing patient care for aor­tic steno­sis in pri­ma­ry care

Symp­toms are the main rea­son for per­form­ing heart aus­cul­ta­tion On aver­age,

• 66% of elder­ly patients are aus­cul­tat­ed because of the pres­ence of cer­tain symp­toms, name­ly pal­pi­ta­tions, chest pain, or short­ness of breath. This high­lights the impor­tance of ensur­ing that patients, their fam­i­lies, and PCPs are famil­iar with the symp­toms of VHD.

• 34% of elder­ly patients are aus­cul­tat­ed as part of a stan­dard check-up/­phys­i­cal exam­i­na­tion (regard­less of the pres­ence of any symp­toms).

Refer­ral after detect­ing a mur­mur

Clear refer­ral path­ways are essen­tial for ensur­ing that elder­ly patients with detect­ed heart mur­murs receive time­ly and coor­di­nat­ed care from appro­pri­ate spe­cial­ists, ulti­mate­ly improv­ing clin­i­cal out­comes and qual­i­ty of life.

The major­i­ty of respon­dents report refer­ring elder­ly patients for a diag­nos­tic test (elec­tro­car­dio­gram or echocar­dio­gram) or to a car­diac spe­cial­ist for fur­ther inves­ti­ga­tion when a heart mur­mur is detect­ed.

Around 14% of elder­ly patients with a heart mur­mur will not be referred to a car­di­ol­o­gist or for a diag­nos­tic test.
Rea­sons for not refer­ring a patient include: unclear refer­ral net­work, patient’s per­son­al pref­er­ence, and long wait­ing time for refer­ral.

Around 6% of patients with a heart mur­mur are referred to a non-car­diac spe­cial­ist. Typ­i­cal­ly, these are patients who suf­fer from oth­er comor­bidi­ties or patients who are already fol­lowed up by a car­di­ol­o­gist due to a pre­vi­ous­ly detect­ed heart mur­mur.

Severe aor­tic steno­sis

Annu­al check-ups play a cru­cial role in the man­age­ment of patients with asymp­to­matic aor­tic steno­sis by facil­i­tat­ing mon­i­tor­ing of dis­ease pro­gres­sion, ear­ly detec­tion of symp­toms, risk assess­ment, and coor­di­na­tion of care.

Respon­dents sug­gest that asymp­to­matic patients with severe aor­tic steno­sis should have a year­ly check-up with a car­di­ol­o­gist, ide­al­ly every six months, and should under­go an elec­tro­car­dio­gram or echocar­dio­gram annu­al­ly.

• 80% of respon­dents agree that there is a low aware­ness of aor­tic steno­sis among patients and care­givers about the dis­ease and its symp­toms and that there is under­diag­no­sis and under­treat­ment of patients over 65 years suf­fer­ing from severe aor­tic steno­sis.

• One in three respon­dents were unsure about how to cat­e­go­rize or assess the seri­ous­ness of a patient’s aor­tic steno­sis.

• One in four respon­dents believe they do not have enough knowl­edge about the avail­able inter­ven­tions (SAVR, TAVI) for treat­ing severe aor­tic steno­sis.