Structural Heart Diseases (SHDs) are structural abnormalities of the heart leading to impaired functioning. They are part of the cardiovascular disease, and include heart valve diseases such as aortic stenosis, mitral or tricuspid regurgitation, that demand valve repair or replacement. Without valve replacement, up to 50 per cent of people with severe aortic stenosis will die within an average of 2 years once symptoms appear. The only way to treat severe aortic stenosis is with a heart valve replacement.
A silent epidemic, SHDs are affecting millions says a new study published by the International Longevity Centre UK. Supported by Edwards Lifesciences, the report titled ‘The Invisible epidemic’ deep dives into rethinking the detection and treatment of structural heart diseases in Europe. A significant condition, SHDs contribute to the burden of disease caused by the rise of preventable illness which results in health, wider social and economic costs as well.
Understanding structural heart diseases
An age-related cardiovascular disease, structural heart diseases carry a high mortality rate if not detected and treated in its infancy, it also decreases the quality of life for those living with the condition. “The challenge of SHDs remains that patients historically had the options of surgery or medical therapies, therefore there has not been any definitive treatment. However, over the last decade, advancements in technology are supporting physicians in giving patients a new lease on life through early prevention, detection, and minimally invasive procedures which aim to treat SHDs,” explains Dr. Syed Sakib Nazir, Specialist Interventional Cardiologist at Fakeeh University Hospital.
As life expectancy is increasing, so is the prevalence of disease, “SHDs are a growing problem as people are living longer. Age is one of the causes of valve diseases, increasing acute and chronic heart failure as well. There are four valves and four chambers inside the heart, when there is a dysfunction of one of these valves or more than one valve, blood circulation gets disrupted. Valve disorder also causes pressure inside the heart chambers to become abnormal, which can lead to dysfunction of the heart as a pump. Valve disease usually causes chronic, which means a long-standing, slow-progressing, pump failure where the patient becomes gradually tired and breathless. Other conditions such as chest infection, or any kind of illnesses, are contributing factors in these chronic conditions becoming acute.”
Dr. Syed Sakib Nazir, Specialist Interventional Cardiologist at Fakeeh University Hospital
A shared burden
It is estimated that 14 million people in Europe suffer from SHDs, according to the study published by the International Longevity Centre UK. When population ageing is factored in, the number of people living with SHDs is expected to rise to 20 million by 2040, representing a 43 per cent increase. Untreated SHDs can place a substantial burden on the hospital and social care systems, as well as society. People with the disease frequently have significant healthcare demands and are unable to contribute to society in ways they could otherwise.
In the last 20 years, the number of hospitalisations owing to SHDs has doubled. Treating SHDs and addressing the associated functional decline has been proven to lower hospitalisations by up to 50 per cent. However, there are ongoing systematic impediments to diagnosing and treating this illness, the most significant of which is widespread ageism. Symptoms such as fatigue and shortness of breath are sometimes rejected as "normal" indicators of aging, resulting in people failing to seek and get care.
“Cardiac surgery is highly specialised, and access is a challenge faced globally. Alternatives to surgery, such as catheter-based technology have evolved over the last 10 years, instead of opening the chest wall or changing the valve, via catheter or tube we can treat the blocked heart arteries. Devices have been developed which can be used via these tubes or catheters to repair the valve instead of replacing it. This has several benefits for the patients and the society, less rehospitalisations, reduced hospital LoS, faster recovery, rapid return to normal life.
Interventional cardiologists and surgeons need to work hand in hand to address the growing burden through raising early prevention awareness, diagnosis, and assessment to decide on an appropriate treatment plan for the patient. Detection is vital as well, as heart murmurs are usually detected when your doctor listens to your heart using a stethoscope during a physical exam,” explains Dr. Syed.
Multidisciplinary approaches and elevated communication between patients and physicians
A multidisciplinary approach engages more than one specialty “The heart team comprises of a cardiologist, interventional cardiologist, surgeon, counsellors, and there may be specialists from other divisions who may be required based on the case. Mainly, the surgeon and interventional cardiologists, assess a patient and try to find a balance between the risk and benefit of doing the procedure and which procedure will be better for the patient,” says Dr. Syed.
Patient engagement, according to the ESC, is a collaborative effort between patients and healthcare providers, which would actively support the aim of lowering the burden of cardiovascular disease. Physician and patient relationships can be elevated through communication, especially for patients who are older and require support comprehending their illness. “There are always some pros and cons of any more modalities of treatment, therefore engaging your patient into the discussion is crucial. For example, the outcome of a surgery is long-lasting, however, for patients opting for transcatheter-based therapy, it is less invasive, provides faster patient recovery, and has similar efficacy. Therefore, this information needs to be relayed to the patient, so they understand the benefits and risks”
Awareness guided by partnerships
The Saudi Health Council and the Saudi Heart Association launched a public awareness campaign on structural heart diseases in the Kingdom of Saudi Arabia, endorsed by Edwards Lifesciences. 17.9 million people lose their lives to heart diseases annually, including valve diseases which affect 13 per cent of those aged above 75.
“We need to educate our population to seek help if they experience certain symptoms. It is important for people over the age of 65 to get their heart checked every year. For heart disease or heart attack, a common indicator is chest pain, which should not be ignored. Likewise, another major giveaway is breathlessness, it can be an important symptom of heart failure, which is a symptom of structural heart disease. Through public awareness campaigns, media channels, and partnerships with government and healthcare authorities, this message should be relayed. We also need to understand that the treatment of structural heart diseases is not easily available, and that is can very expensive.
A very specialised set of skills is required to treat patients who suffer from SHDs. A collaboration between government and private hospitals can help foster successful patient outcomes. A hospital that has a facility for catheter-based treatment for structural heart diseases, can with a good networking system or internal reference system work with other hospitals and primary healthcare centers. This can form a strong partnership with other care providers. A great initiative by the government is centralising patient data. By using an MRN number, a patient’s medical history can be retrieved, this is extremely helpful in learning more about the patient and their conditions, especially when they are older,” concludes Dr. Syed.