New paper highlights the rapid rise in valvular heart disease


A new report from the Baker Heart and Diabetes Institute has revealed the rapidly increasing number of people living with valvular heart disease that could lead to serious complications.

Edwards Lifesciences provided an unrestricted educational grant to the Baker Institute to produce the paper. 

The report - ‘Our Hidden Ageing – Time to Listen to the Heart’ - shows more than half a million Australians have valvular heart disease, including narrowing (stenosis) and leaking (regurgitation).

Yet more than one-quarter of a million Australians have faulty heart valves, and are at risk of serious complications, and do not even know it. The report says these complications include heart failure, stroke, blood clots, heart rhythm abnormalities, and even death.

It says the number of undiagnosed cases of valvular heart disease is projected to rapidly increase - to 336,000 cases in 2031, and 435,000 in 2051. This will put a significant burden on Australia's health system.

According to cardiologist, researcher and lead author of the whitepaper, Professor Tom Marwick, “Ageing causes the blood vessels to progressively lose elasticity and become stiff, impacting the vascular structure and function. This arterial damage increases mechanical stress on the valves, which are also susceptible to the same threats.

“A heart murmur is often the first symptom of heart valve disease.

“It is important to keep in mind that the common symptoms of heart valve disease - especially exercise intolerance - are often misattributed to ‘old age’.”

While there are four main causes of valvular heart disease, including a congenital defect, family history and infection or inflammation, degenerative heart disease far exceeds the other causes.

Aortic valve disease is the most frequent cause of severe valvular heart disease. Its most common manifestation is aortic stenosis – a moderate-to-severe narrowing of the aortic valve - with cases predicted to climb to 200,000 in 2031 and 266,000 in 2051.

Professor Marwick says valvular heart disease is serious but also increasingly treatable.

Previously, people living with aortic stenosis had few options to replace their unhealthy aortic valve, including open-heart surgery. However, aortic stenosis is now the most treatable valve lesion due to the development of non-surgical valve replacement, such as transcatheter aortic valve implantation (TAVI).

Edwards Lifesciences is a leader in TAVI technology that is currently considered for people with severe and symptomatic aortic stenosis. However, untreated, moderate stenosis may also have an adverse impact.

Modelling in the Baker Institute paper shows that offering a TAVI for people aged 65 years and over could potentially prevent $117 million in productivity loss in a single year due to withdrawal from productive activities.

Professor Marwick and other cardiovascular experts are calling for action from the federal government.

“We need increased awareness through marketing campaigns; strategies to upskill and support primary care; financial support for the use of emerging technologies; health service design, including improved access to echocardiography; funding to improve access and equity to interventions; and development of national heart valve disease guidelines,” said Professor Marwick.

“Heightened awareness and education is critical to ensuring older Australians are aware of this disease, and to adequately support GPs to identify people at risk, and provide appropriate treatment before they develop a major cardiovascular problem.”

Professor Marwick said performing a thorough physical examination of the cardiovascular system, including auscultation (listening), should form part of an annual GP check-up for every Australian over 65 years of age.

“Any abnormalities should then be further examined via echocardiography – the test of choice for valvular heart disease.

“Doctors should also take advantage of innovations in detection, diagnosis and treatment of valvular heart disease. The use of the digital stethoscope and handheld ultrasound may vastly improve the detection of valvular heart disease in the community,” he says.

“We must all keep in mind that valvular heart disease can go unrecognised, undiagnosed, and untreated, and the complications can be devastating.”