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Specialist valve clinic: why, who and how?
  1. John B Chambers
  1. Guy's and St Thomas' Hospitals, London SE1 7EH, UK
  1. Correspondence to Professor John B Chambers, Guy's and St Thomas' Hospitals, London SE1 7EH, UK; jboydchambers{at}aol.com

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Learning objectives

  • To understand why a specialist valve clinic is needed.

  • To understand the clinical and organisational needs of a valve clinic and how these differ from a general clinic.

  • To understand the links between a valve clinic and broader aspects of a specialist valve service.

  • To understand which cardiac conditions can be managed in a specialist valve clinic.

  • To understand the elements of a consultation focused on valve disease.

Introduction

Specialist outpatient clinics were first established by cardiologists with a broader involvement in valve disease including inpatient opinions and care (figure 1).1 2 This article will concentrate on the core outpatient clinic.

Figure 1

Roles of a specialist valve clinic. This includes the clinical and organisational aims of the valve clinic itself and the broader aims of a comprehensive valve service. GP, general practitioner, MDT, multidisciplinary team meeting.

Guidelines3–5 now recommend prophylactic surgery for severe mitral regurgitation caused by prolapse provided that repair can be virtually guaranteed at close to zero risk. This has led to discussion of service requirements and quality standards to define ‘heart valve centres’.6 7 Valve clinics are important in a heart valve centre since their core aim is to follow patients and refer to a surgeon before significant left ventricular (LV) decompensation or adverse clinical events supervene. However, valve clinics can also improve care in district hospitals with no onsite cardiac surgery or transcatheter programmes.

It is easy to see valve care almost exclusively in terms of surgery or interventional procedures since these dominate cost, commercial concerns, news items and in consequence governmental and regulatory discussions. However, the majority of patients in hospital services are initially managed conservatively (figure 2).8–11 Furthermore, a large proportion of patients with valve disease are undiagnosed or being seen within the community and better methods of detection and …

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