Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients

Abstract

Cardiac auscultation has limited accuracy for the detection of VHD in asymptomatic patients and is a poor diagnostic screening tool in primary care, particularly for overweight subjects. Ensuring easy access to echocardiography in patients with symptoms suggesting VHD is likely to represent a better diagnostic strategy.

Bridging gaps in heart valve disease care: Opportunities for quality improvement

“…Yet, as of 2016, researchers found that 30% of Americans ages 65 years and older were not aware of heart valve disease . Furthermore, evidence shows that a large proportion of heart murmurs, which often serve as a primary diagnosis for heart valve disease, are often missed by primary care . Lastly, ~1 in 3 patients with symptomatic aortic stenosis would rather medically manage their valve disease than select treatment options because their preferences are usually not aligned with the treatments selected for them .…”

“…26 Furthermore, evidence shows that a large proportion of heart murmurs, which often serve as a primary diagnosis for heart valve disease, are often missed by primary care. 25,27 Lastly,~1 in 3 patients with symptomatic aortic stenosis would rather medically manage their valve disease than select treatment options because their preferences are usually not aligned with the treatments selected for them. 28 These findings demonstrate that there is an opportunity to improve the care continuum of patients with heart valve disease from identification and management to selection of treatment.…”

Heartbeat: Time to switch from aortic valve area to aortic valve index?

“…The diagnosis of AS is often missed on physical examination by primary care providers 1. Even when an echocardiogram is obtained, discrepancies in measures of AS severity can lead to confusion and failure to refer patients for appropriate intervention.…”

Mind the gap: missed valve disease diagnosis

“…In their  Heart  paper, Gardezi and colleagues5 evaluated the accuracy of cardiac auscultation for detection of valve disease by primary care providers, compared with echocardiography, in 251 asymptomatic patients over age 65 years with no prior diagnosis of heart valve disease. Remarkably, significant valve disease was present in 14%, and mild valve disease was present in the majority (68%) of these patients.…”