Self-Reported Utilization of International (ACVIM Consensus) Guidelines and the Latest Clinical Trial Results on the Treatment of Dogs with Various Stages of Myxomatous Mitral Valve Degeneration: A Survey among Veterinary Practitioners

Abstract

Background: Myxomatous mitral valve degeneration is the most common canine heart disease. Several clinical trials have investigated various treatments. The latest recommendations are published in the ACVIM consensus guidelines (2019). Our study aimed to investigate how closely veterinary practitioners apply the treatment recommendations of these guidelines and the latest clinical trials. Methods: An online survey was sent to Dutch and Belgian veterinary practices via digital channels. Results: The data from 363 fully completed surveys were analyzed. For stage B1 disease, 93% recommended, correctly, no treatment. For stage B2 disease, 67% of the respondents recommended starting pimobendan as monotherapy. For chronic treatment of stage C disease, 16 different drug combinations were mentioned, but nobody recommended surgery. Only 48% of the respondents recommended the only evidence-based drug combination: a loop diuretic with pimobendan. A concerning finding was the simultaneous prescription of two loop diuretics, by 19% of the respondents. Conclusions: Treatment recommendations showed an increasing variation with more advanced disease stages from B1 through B2 to C. This reflects the increasing disagreement among the panelists who prepared the ACVIM consensus guidelines. Practitioners of our study seem to practice more evidence-based medicine than veterinary cardiologists, as it was reported in a recent survey-based study.

Self-Reported Management of Incidentally Detected Heart Murmurs in Puppies: A Survey among Veterinarians

“…The very last (47th) question of the combined survey, after the questions on adult dogs with a murmur [ 19 , 20 ], asked the participants about what they needed to improve the management of their cardiac cases. This question was filled in by 327 respondents.…”

“…However, 36% of them did want to get trained in echocardiography. An additional 25% said that they needed nothing else to improve the management of their cardiac cases [ 19 , 20 ].…”

“…Despite the low percentage of respondents who find the differentiation of innocent from pathologic murmurs easy, none of the respondents mentioned wanting to improve their auscultation skills. Instead, many respondents wished to learn echocardiography [ 19 , 20 ]. Difficulties in differentiating innocent from pathologic murmurs have been reported in pediatric cardiology too, as general practitioners face the same challenges as their veterinary counterparts [ 28 ].…”

“…However, according to the results of a recent study, in 88% of cases of myxomatous mitral valve degeneration veterinary cardiologists needed to alter the medical therapy after referral, while mitral valve degeneration is the most common heart disease in dogs [ 33 ]. This finding shows that optimizing therapy by veterinary cardiologists is required for even the most prevalent heart disease, for which a consensus statement is available [ 19 , 20 ]. Therefore, puppies with congenital heart diseases would benefit even more from referral to a veterinary cardiologist, as general veterinary practitioners seldom encounter such patients and there are no consensus statements for any of the congenital heart diseases available.…”

“…Our study was conducted via a web-based survey in the Netherlands and Belgium between 1 July 2021 and 15 August 2021, and it was part of a larger study [ 19 , 20 ]. The online questionnaire (powered by Qualtrics, Provo, UT, USA) was distributed among veterinary practices via multiple online sources: the electronic newsletter of the Royal Dutch Veterinary Association (KNMvD), a Dutch veterinary online discussion platform (Het Dierenartsen Gilde, hosted by Facebook), a mailing list of a veterinary event agency (Vitaux), newsletters of a global veterinary care franchise (Evidensia), and newsletters of two pharmaceutical companies (Boehringer Ingelheim and Vetoquinol).…”