This article appears as part of the Inside the NHS newsletter.
It is International Heart Valve Awareness Week - but how well is Scotland's NHS doing at diagnosing and treating patients suffering from valve disease?
Not well enough, according to cardiologists.
It is estimated that around 73,000 people in Scotland are living with some form of heart valve disease (HVD) but that one in three are undiagnosed, and fewer than 2000 people a year are undergoing surgery to repair or replace faulty valves.
If left untreated, HVD can lead to heart failure and sudden death.
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Dr Jonathan Byrne, a consultant cardiologist and UK lead for the Valve for Life programme - a global initiative campaigning to increase access to HVD treatments - said: “There is capacity in Scotland to undertake thousands more procedures and keyhole surgeries annually for people with moderate and severe heart valve disease, but underdiagnosed patients represent a huge challenge for us as they will remain undertreated.”
In the meantime, members of the public over 50 - with or without symptoms - are being invited to take part in a free screening event on Thursday September 19.
A team - from the Royal Infirmary of Edinburgh and the Golden Jubilee hospital - hope to carry out heart checks on more than 200 adults via a 'Your Heart Matters' truck at the Asda Chesser Supercentre in Edinburgh .
'Very hard to see a GP'
According to Dr Stuart Watkins, a consultant cardiologist based at the Golden Jubilee hospital in Clydebank, there are two main reasons cases are being missed.
Firstly, an ageing population means that there are more cases out there. Prevalence rises from around 0.2% in the 50-59 age group to 10% among 80 to 89-year-olds.
The most common symptom is breathlessness, but some patients will experience chest pain, dizziness, or blackouts.
Others experience no symptoms, making detection harder.
Secondly, Dr Watkins says a reduction in face-to-face consultations means doctors have fewer opportunities to examine patients' chests using a stethoscope.
He said: "When you speak to patients, they complain that it's very hard to see a general practitioner.
"I'm forever being told in clinics that they had an appointment but it was a telephone consult.
"GPs are flat out and there's not enough of them, but people are not getting their hearts listened to as much as they used to, so we're not picking cases up in the same way."
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Lagging behind?
Depending on the problem, there are three main types of valve surgery:
- TAVI (Transcatheter Aortic Valve Implantation) is a minimally invasive procedure to treat aortic stenosis by inserting a new valve
- TEER (Transcatheter Edge-to-Edge Repair) repairs the mitral valve to correct leaky blood flow
- SAVR (Surgical Aortic Valve Replacement) is a form of open-heart surgery to treat severe aortic stenosis in patients at higher risk of complications.
Aortic stenosis is the most common valve condition.
Half of patients diagnosed at a late stage - when the valve has narrowed severely, blocking blood flow to the body's main artery - will die within a year without treatment.
In 2022/23, there were 575 TAVI procedures performed in Scotland - up nearly 18% year-on-year. In addition, roughly 1000 SAVRs and 200 TEERS are carried out annually.
However, Scotland has been comparatively slow to adopt TAVI.
Until 2018, Scotland had only one specialist centre - the Royal Infirmary of Edinburgh - for the procedure.
In 2018, the Golden Jubilee came on board, followed by Aberdeen Royal Infirmary in 2019.
England and Wales already had several centres, but the UK as a whole trails Europe.
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By 2017, Germany was performing TAVI at an annual rate of 235 procedures per million population.
That compares to around 106 per million today in Scotland.
Dr Watkins said: "[Scotland is] catching up with the rest of the UK in terms of our number per million, but we're still slightly behind.
"But for the UK as a whole, we're a long way behind the likes of Germany."
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