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.

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 …