by Professor Neal Uren, Professor of Interventional Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh

Covid-19 has posed many challenges to the Scottish healthcare system, and not least for those with life-threatening heart complications. Following the good news from the recent vaccination clinical trials, and as we hopefully ready ourselves for a return to normality in mid-2021, this is an opportune moment to reflect on how we can build back better for Scottish patients.

Approximately 130,000 Scots over the age of 65 live with moderate or severe heart valve disease (whereby the valves of the heart decline over time) such as aortic stenosis and mitral regurgitation, and the likelihood of developing such conditions increase with age.  All developed countries have an ageing population; the total population of over 65s in 2018/2019 in Scotland was 1,034,0661 people, and by 2030 the Office for National Statistics predict a 29% increase of those aged between 65-84 and a 56% increase in those aged over 85.

We know that if significant valve disease is detected early and given the right intervention, patients can lead normal and fulfilling lives after surgery or catheter-based intervention. Observational data from a Heart Valve Voice survey in 2020 indicated that 94% of European’s over 60 are unaware of the condition of aortic stenosis, one of the most common and serious forms of heart valve disease (HVD), and only 6% said HVD is a condition that gives them significant concern compared to other illnesses. This is despite annual mortality of untreated and severe aortic stenosis being considerably higher than some cancers.

In my experience leading a team at the Royal Infirmary of Edinburgh, I know that public awareness of heart valve disease is key.  We therefore need to see more awareness-raised amongst the medical community in Scotland, focusing on the importance of early detection and diagnosis of heart valve disease in upcoming public health and cardiovascular policy plans.  

It is also time for a nationwide framework for heart valve disease detection, diagnosis, and management, indicating when patients should be referred for diagnosis and intervention, taking the best of Scotland’s medical expertise and combining it with the political and public drive to raise this in the public consciousness.

Professor Neil Uren
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