Abstract
International best practice guidelines recommend lifelong follow-up of patients that have undergone valve repair or replacement surgery and provide recommendations on the utilization of echocardiography during follow-up. However, such follow-up regimes can vary significantly between different centres and sometimes within the same centre. We undertook this study to determine the patterns of clinical follow-up and use of transthoracic echocardiography (TTE) amongst cardiologists in a large UK tertiary centre. In this retrospective study, we identified patients that underwent heart valve repair or replacement surgery in 2008. We used local postal codes to identify patients within our hospital’s follow-up catchment area. We determined the frequency of clinical follow-up and use of transthoracic echocardiography (TTE) during the 9-year follow-up period (2009–2016 inclusive). Of 552 patients that underwent heart valve surgery, 93 (17%) were eligible for local follow-up. Of these, the majority (61/93, 66%) were discharged after their 6-week post-operative check-up with no further follow-up. Of the remaining 32 patients, there was remarkable heterogeneity in follow-up regimes and use of TTE. This variation did not correlate with the prosthesis type. In summary, the frequency of clinical follow-up and use of echocardiography is highly variable in contemporary practice. Many patients are inappropriately discharged back to their family doctor with no plans for hospital follow-up. These data further support the creation of dedicated specialist heart valve clinics to optimize patient care, ensure rational use of TTE and optimize adherence with best practice guidelines.
Highlights
There has been renewed clinical and research interest in valvular heart disease (VHD) over the past decade, fuelled in part by innovations in percutaneous treatment options as well as advances in imaging that allow for more precise assessment of the impact of VHD on the myocardium
For patients that died during the follow-up period of the study (2009–2016), we examined clinical and echocardiographic follow-up each year until their death to determine whether follow-up practice was appropriate whilst alive following surgery
Patients were seen by the consultant, a cardiology registrar or senior house officer (SHO)
Summary
There has been renewed clinical and research interest in valvular heart disease (VHD) over the past decade, fuelled in part by innovations in percutaneous treatment options as well as advances in imaging that allow for more precise assessment of the impact of VHD on the myocardium. 5:3 models of care and practice for valve disease surveillance and follow-up have been published, including specialist heart valve clinics [1, 2, 3]. Patients with prosthetic heart valves (PHVs) require lifelong specialist follow-up to monitor for shortand long-term complications including prosthesis failure. International guidelines [4, 5] exist recommending frequency of follow-up including utilization of echocardiography, follow-up regimes of PHV patients vary significantly between different centres and sometimes within the same centre
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
