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Outpatient management of heart valve disease following the COVID-19 pandemic: implications for present and future care
  1. Benoy Nalin Shah1,
  2. Dominik Schlosshan2,
  3. Hannah Zelie Ruth McConkey3,
  4. Mamta Heena Buch4,
  5. Andrew John Marshall5,
  6. Neil Cartwright6,
  7. Laura Elizabeth Dobson4,
  8. Christopher Allen7,
  9. Brian Campbell8,
  10. Patricia Khan9,
  11. Peter John Savill1,
  12. Norman Paul Briffa6,
  13. John Boyd Chambers8
  1. 1 Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
  2. 2 Cardiology, Leeds General Infirmary, Leeds, UK
  3. 3 Cardiology, Royal Berkshire Hospital, Reading, United Kingdom
  4. 4 Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, Greater Manchester, UK
  5. 5 Cardiology, East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK
  6. 6 Cardiac Surgery, Northern General Hospital, Sheffield, Sheffield, UK
  7. 7 Guy's & St Thomas' Hospital, Kings College, Rayne Institute, London, London, UK
  8. 8 Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
  9. 9 British Heart Valve Society, London, UK
  1. Correspondence to Dr Benoy Nalin Shah, Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK; benoy.shah{at}


The established processes for ensuring safe outpatient surveillance of patients with known heart valve disease (HVD), echocardiography for patients referred with new murmurs and timely delivery of surgical or transcatheter treatment for patients with severe disease have all been significantly impacted by the novel coronavirus pandemic. This has created a large backlog of work and upstaging of disease with consequent increases in risk and cost of treatment and potential for worse long-term outcomes. As countries emerge from lockdown but with COVID-19 endemic in society, precautions remain that restrict ‘normal’ practice. In this article, we propose a methodology for restructuring services for patients with HVD and provide recommendations pertaining to frequency of follow-up and use of echocardiography at present. It will be almost impossible to practice exactly as we did prior to the pandemic; thus, it is essential to prioritise patients with the greatest clinical need, such as those with symptomatic severe HVD. Local procedural waiting times will need to be considered, in addition to usual clinical characteristics in determining whether patients requiring intervention would be better suited having surgical or transcatheter treatment. We present guidance on the identification of stable patients with HVD that could have follow-up deferred safely and suggest certain patients that could be discharged from follow-up if waiting lists are triaged with appropriate clinical input. Finally, we propose that novel models of working enforced by the pandemic—such as increased use of virtual clinics—should be further developed and evaluated.

  • valvular heart disease
  • echocardiography

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  • Twitter @dr_benoy_n_shah, @MCRImaging, @BrianCampbellCS, @chestcracker

  • Contributors BNS and JBC wrote the first draft of the article, which was subsequently revised and appraised on several occasions by all other authors. BNS is the guarantor for this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note British Heart Valve Society - @BrHeartValveSoc