Valvular & structural heart disease
Educational needs and application of guidelines in the management of patients with mitral regurgitation. A European mixed-methods study
Authors' conclusion
Systematic auscultation is underused by PCPs for the early detection of MR. Medical therapy is overused in primary MR and underused in secondary MR. Indications for interventions are appropriate in most patients with primary MR, but are unexpectedly frequent for secondary MR.
Study context
- Population
- Clinicians from seven European countries managing mitral regurgitation (asymptomatic severe primary MR, symptomatic severe primary MR in the elderly, severe secondary MR)
- Participants
- 115 vs 439
- Exposure
- Primary care physicians (PCPs) vs cardiologists or cardiac surgeons
- PCPsn = 115
- Cardiologists or cardiac surgeonsn = 439
- Outcome
- Knowledge and application of European Society of Cardiology (ESC) Guidelines in MR management
Methodological detailsqualitative interviews and online case-scenario survey, seven European countries, three case scenarios, Qualitative phase (interviews) followed by online survey
- Qualitative interviews and online case-scenario survey
- Seven European countries
- Three case scenarios
- Qualitative phase (interviews) followed by online survey
Main finding
As reported in the abstract
Guideline knowledge and application in case scenarios
- Systematic cardiac auscultation in asymptomatic patients (clinicians)
- 54%
- Cardiologists appropriately interpreted echo mechanism and quantification of primary MR
- ≥75%
- Cardiologists recognising secondary MR as severe
- 44%
- Asymptomatic severe primary MR with surgical indication: PCPs not referring to cardiologist
- 27%
- Asymptomatic severe primary MR with surgical indication: cardiologists overusing medical therapy
- 19%
- Elderly severe symptomatic primary MR: cardiologists considering mitral intervention
- 72%
- Elderly severe symptomatic primary MR: transcatheter edge-to-edge repair among interventions
- 72%
- Severe symptomatic secondary MR: optimisation of medical therapy advised by PCPs
- 51%
- Severe symptomatic secondary MR: optimisation of medical therapy advised by cardiologists
- 33%
- Severe symptomatic secondary MR: surgery considered
- 30%
- Severe symptomatic secondary MR: transcatheter edge-to-edge repair among interventions
- 64%
Observational data: associations, not effects.
Original publication
Educational needs and application of guidelines in the management of patients with mitral regurgitation. A European mixed-methods study. Eur Heart J. Published 2 January 2018. doi:10.
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