Cardiovascular care in the older adult: Valvular heart disease
This resource series, curated by the BGS Cardiovascular SIG, brings together key principles and guidelines on the management of cardiovascular disease in older adults.
Valvular heart disease is a major cause of morbidity and mortality in older adults. While cases related to rheumatic heart disease have declined in the Western world, our ageing population has dramatically increased the incidence of degenerative valve disease. It is estimated that 1 in 8 adults over 75 years old now have significant (moderate or severe) valve disease, even if asymptomatic. The most common valve conditions in older adults are aortic stenosis and mitral regurgitation.
Key guidelines
- Guidelines for the management of valvular heart disease (2017) - ESC/EACTS
These are comprehensive guidelines for the management of valvular heart disease from the European Society of Cardiology. It is particularly worth noting a short section on special considerations in older adults (section 3.3).
- AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (2017)
This is the main US guideline in this field. There is limited specific guidance around older adults, although frailty is acknowledged.
A NICE review of valvular heart disease in adults is expected in 2021 and will address multimorbidity and frailty in these populations.
Recommended reading
- Older population screening for undiagnosed valvular heart disease: the OxVALVE Population Cohort Study
This landmark UK study identified the burden of undiagnosed valvular heart disease amongst older (≥65 years old) adults
- Valvular Heart Disease in Patients ≥80 Years of Age
This state-of-the-art review from the Journal of the American College of Cardiology provides a clear description of the challenges in assessment and management of managing valvular heart disease in older adults, including some of the modified treatment options available.
- Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve
This key US study is one of several that support the safety of bioprosthetic valves in older adults requiring aortic or mitral valve replacement, to avoid the potential bleeding risks from anticoagulation required for mechanical valves.
- FRAILTY-AVR study
This is the largest multi-centre observational study of frailty measurements and outcomes for patients treated with aortic valve replacement. It suggests a brief frailty test (the “Essential Frailty Toolkit”) as an effective predictor of risk in older adults with severe aortic stenosis.
- Cardiovascular care in the older adult: TAVI
There is further relevant information for Transcatheter Aortic Valve Implantation (TAVI) in our dedicated section on this topic.