New guidelines on valvular heart disease released

Cardiology experts released new updated guidelines on the management of valvular heart disease (VHD) last week.

The American Heart Association/American College of Cardiology (AHA/ACC) guideline on VHD was last updated in 2008, and among the changes in the 2014 version are new stages of disease severity for categorizing the disease:

• Stage A: at risk for VHD
• Stage B: progressive VHD
• Stage C: asymptomatic, severe VHD
• Stage D: severe, symptomatic VHD

The new guideline lowers the threshold for intervention for some patient populations (such as those with severe asymptomatic aortic stenosis or mitral regurgitation) and provides a new scoring system for evaluating surgical and interventional risk. The score is based on the patient's frailty, major organ system compromise, procedure-specific impediments and the Society of Thoracic Surgeons predicted risk of mortality score.

Other additions in the latest version of the guideline include discussion of transcatheter aortic valve replacement and heart valve team care. The format has also changed to include decision pathway diagrams and summary tables, which will make the guideline easier to use at the point of care, according to a press release.

In addition to the AHA and ACC, the American Association for Thoracic Surgery, American Society for Echocardiography, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons collaborated on the guideline development. It will be published in the Journal of the American College of Cardiology and Circulation.

The full guideline and an executive summary were released online March 3.