50% Of Eligible Patients Do Not Get Mitral Regurgitation Treatment
The University of Michigan Cardiovascular Center just released a rather troubling study about patients who are diagnosed with mitral regurgitation and do not receive surgical treatment. I guess this is one more reason why second opinions are so valuable. Here are the details:
Overblown fears about (i) surgical risk and (ii) lack of awareness about the risk of not operating are among the reasons only half of eligible patients were referred for mitral valve repair, according to a study by doctors at the University of Michigan Cardiovascular Center.
Mitral Valve Repair (Annuloplasty)
A leaking mitral valve, known as mitral regurgitation or mitral insufficiency, can lead to fatigue, abnormal heart rhythms with irregular heart beats, and congestive heart failure. The longer the leak continues, the more likely there will be permanent heart damage.
Among those patients not operated on, 75% met at least one indication for surgery, according to guidelines from the American College of Cardiology and the American Heart Association.
“In general, cardiologists tend to overestimate the risks of surgery and underestimate the potential benefits for patients,” says lead author David S. Bach, professor of internal medicine at the U-M Medical School and cardiologist at the U-M Cardiovascular Center.
Researchers identified 300 patients with moderate-to-severe mitral regurgitation for the study in the Journal of the American College of Cardiology. Patients had been screened in the University of Michigan Echocardiography Laboratory.
Among them, 188 patients had functional mitral regurgitation, of whom just 30 underwent surgery. Of the 112 patients with severe mitral valve regurgitation, only half had surgery. Surgical risk scores were no different among patients who underwent surgery compared to those who did not.
Existing data show deaths among patients undergoing mitral valve surgery have decreased dramatically in recent years, making the procedure a feasible option.
“I think there remains something of a bias in medicine and cardiology that surgery is risky, and surgery is a failure of our ability to manage the patient medically,” Bach says in an interview. “Mitral valve diseases are not as benign as they were once thought to be, and surgery is not as morbid as it was thought of in the past.”
A review of patient charts showed the most common reasons for not referring patients for surgery were stable heart functioning, an absence of symptoms or presence of other major health problems.
Bach sees mitral valve conditions – even relatively common ones like mitral regurgitation – as prime examples of conditions that might best be treated in specialized centers with the volume and familiarity to use appropriate interventions and minimize inappropriate ones.
Meanwhile, Bach suggests cardiologists become more familiar with guideline recommendations and the data on which they are based, discuss options more fully with patients, and when possible, involve a surgeon in consultation.
Keep on tickin!
P.S. To leave a comment, please click here.
About The Author: Adam Pick is a double, heart valve surgery patient and author of The Patient’s Guide To Heart Valve Surgery. This unique book integrates the clinical facts of heart valve surgery with the personal experiences of 78 former valve surgery patients to help patients and caregivers better understand the problems, the opportunities and the realities of heart valve surgery. To learn more about Adam and his heart valve surgery book, click here.
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September 15th, 2009 at 1:18 pm
I am not surprised by this at all. I did not get recommended for surgery until after I changed cardiologists. My surgeon talked about getting it and repairing it earlier since it is such a safe procedure now. I had my surgery on July 8th and am feeling great!
September 15th, 2009 at 1:32 pm
Great to hear you’re doing well Steve!
This just came in from Linda:
I was one of these patients.
No symptoms but an echo showed severe regurgitation. I was lucky to have a cardiologist who believes in repair while it can still be done. My surgery was successful and the repair on my mitral valve should be good for life. If I had waited another year or so I would likely be facing a replacement and damage to my otherwise healthy heart.
Side note… As a 52-year old female I requested a full cardiac work-up where this was diagnosed. My general practitioner never heard the mitral valve problem in check-ups. We must take charge of our health before we are symptomatic and our options limited.
Linda
September 15th, 2009 at 2:14 pm
This concerns me greatly. I’ve had slowly increasing regurg since being diagnosed in early 2002. I’m now “low moderate” and have had extra beats and a few other small irregularities. I don’t remember either cardiologist asking about symptoms, yet I’ve complained to my original cardiologist about a little light-headedness and to my internist for years about fatigue. My original interventional cardiologist (who moved out of state) was considered one of the best and the doctor from his former heart center who I am now seeing has a good reputation as well. When should patients become concerned that they may not be getting the best advice?
September 26th, 2009 at 6:23 pm
I too fall into the category of patients that never got referred for surgery. The cardiologist always said, “you don’t want to have open heart surgery”. That type of “care” resulted in a very bad turn of events where I ended up in ICU for a week due to “pneumonia”. The doctors will not tell me just what happened that landed me in ICU but I do know I had a breathing tube and other tubes. After getting my “strength back” a pulmonary expert suggested that I have the mitral valve surgery. The cardiologist still thought I should put off surgery. I went ahead with the surgery. A repair was done; it’s been almost a year and although my “murmur is back”, I am told that it is not as serious as before. Although this is not what I wanted to hear, I do feel much better. However, occasionally, I still wonder how long before I will have to undergo another procedure. This blog is indeed very helpful. If anyone out there has had a mitral valve repair that wasn’t completely successful, what has been planned in handling the murmur? By the way, concern should be exercised when you really do not feel well and cannot function regardless of what your cardiologist might say. You should know your body better than anyone else.
September 27th, 2009 at 8:23 pm
Hi Adam
My MVP with regurgitation this year is 50%, up 1% from last year. My cardiologist this past spring said that at one time they would have waited for my condition to get even worse but he had just recently come from a symposium where it was decided to treat this condition a little earlier before serious symptoms such as enlargening of the ventrical or congestive heart failure set in. I was referred to a surgeon who still wasn’t convinced I needed the surgery but shortly afterwards symtoms did start to arise so some diagnostic testing was completed and now I’m heading off to surgery. Leading up to this I had been under the impression I may never need surgery but once my lifestyle became affected, the need for intervention became obvious. One of the questions the cardiologist always asked me was if my lifestyle was being affected and up until recently the answer was no. It’s a huge step but not one I see as being a choice. I’m hoping for a repair so wish me luck. Cheryl, Canada
October 4th, 2009 at 1:08 pm
Yolanda, I too had a mitral valve repair that was not completely successful. During the surgery they thought it looked good, but once my heart was again beating on its own it was found I still have moderate regurgitation it had been severe with my MVP prior to operating. So, I still have my murmer though it is less than before. It is thought that maybe 20 years down the road I may have to have another surgery. I am only 36 now, I hope technology for heart surgery is much better by then and it will not be as stressful. I am still suffering with complications of my surgery in December 2008