NEW YORK (Reuters Health) – Only about half the patients with severe mitral regurgitation who meet current heart society guidelines for surgical intervention actually undergo mitral surgery, according to a report from the University of Michigan.

“The treatment of patients with heart valve disease appears to have taken a bit of a back seat to the treatment of other conditions in cardiology,” Dr. David S. Bach from University of Michigan, Ann Arbor, told Reuters Health in an email. “This could be because heart valve disease is relatively less common than other conditions like coronary artery disease, atrial fibrillation, and heart failure.”

Dr. Bach and colleagues used American College of Cardiology/American Heart Association guidelines to determine whether 300 patients with echocardiographic evidence of moderate-to-severe or severe mitral regurgitation should have had interventions.

According to their report in the August 25th Journal of the American College of Cardiology, only 53% of 112 patients with organic mitral regurgitation underwent surgery.

The most common reasons for not performing surgery were related to a belief that mitral regurgitation was not a current threat based on stable chamber sizes, absence of symptoms, or less mitral regurgitation noted on a subsequent echocardiogram.

“Although subsequent mitral regurgitation improvement could be a logical reason to defer intervention,” the investigators point out, “most patients met other criteria for intervention. Further, guidelines do not recommend continued follow-up once an indication for intervention is present.”

“Together, these findings suggest a lack of familiarity with longstanding guideline recommendations or a lack of respect for them,” the authors conclude.

An even smaller proportion of patients with functional mitral regurgitation (16%) or ischemic mitral regurgitation (16%) underwent mitral surgery, the researchers note, but low rates of intervention for these patients are expected and are not in conflict with guideline recommendations or standards of care.

Still, overall, one or more indications for intervention was present in about three-quarters of patients who did not have surgery, “suggesting poor adherence to guideline recommendations,” the authors note.

“In an atmosphere of current public policy addressing health care in a broader sense, I see heart valve conditions — even relatively common ones like mitral regurgitation — as prime examples of conditions that would be best treated in specialized multi-disciplinary programs at specialized centers, where expertise and volume lead to familiarity with guidelines and the data on which they are based; as well as both access to and proficiency with the best tools for diagnosis, therapy, and assessment of risks and benefits,” Dr. Bach said.

Reference:
J Am Coll Cardiol 2009;54:860-865.