A New Benchmark for Modern Management of Valvular Heart Disease: The Whole-Life Cycle Management System

Abstract

Valvular heart disease (VHD) is rapidly increasing in prevalence worldwide, affecting millions and significantly impacting global health care systems. Despite notable advancements in understanding VHD progression, perioperative management, imaging techniques, and transcatheter therapies over the past 2 decades, the condition has not received the attention it deserves from the public and policymakers. Many patients with VHD in low- and middle-income countries continue to experience low detection, intervention, and follow-up rates. Systematic care for elderly patients and those with severe comorbidities, as well as postoperative patients, remains insufficient, leading to higher mortality and morbidity rates. This review focuses on the deficiencies in VHD treatment within the Chinese health care system and discusses the modern management program, known as the whole-life cycle management system, that has been implemented to enhance the survival prognosis of VHD patients.

Keywords: heart valve clinic; integrated; multidisciplinary team; valvular heart disease; whole-life cycle.

Graphical abstract

Figure 1

The Causes, Status, and Outcomes of Management Deficiencies in VHD Valvular heart disease (VHD) patients encounter numerous challenges in the diagnosis and treatment process, primarily because of confusion surrounding medical management. First, the general lack of health awareness among elderly patients, combined with the slow and insidious progression of valvular lesions and the insufficient diagnostic tools, has resulted in a low detection rate. Second, delayed referrals often lead to missed interventions, while gaps between existing guidelines and their implementation, along with regional disparities, prevent some patients from receiving timely treatment, resulting in overall low intervention rates. Finally, public neglect of mild lesions, insufficient continuous monitoring and transitional of care, and ineffective referral systems contribute to low rate of repeat visits. Collectively, these factors contribute to the widespread development of structural heart failure in VHD patients, thereby increasing mortality rates.

Figure 2

Multidisciplinary Heart Team Heart Valve Clinics usually consist of cardiologists with expertise in valvular heart disease (VHD) and trained nurses. The heart team is a new concept in the treatment of cardiovascular disease that aims to develop the best treatment plan for the patient. Team members include heart failure specialists, cardiac surgeon, interventional cardiologist, cardiac imaging experts, cardiopulmonary physical therapist, electrophysiological experts and geriatrics experts. The Heart Valve Clinic combined with the heart team together form the Heart Valve Centre. Through shared decision-making among team members, we can comprehensively analyze patient symptoms and disease progression, reduce decision-making bias, decrease disease severity, shorten waiting times for interventions, increase guideline adherence, and ultimately reduce mortality.

Figure 3

Common Heart Valve Clinic Models The 3 current models for integrating Heart Valve Clinics with heart teams are as follows: Model A, in which cardiologists refer all patients with moderate-to-severe valvular heart disease (VHD) to a multidisciplinary team for evaluation; Model B, in which cardiologists independently determine the necessary treatment for each patient and refer them to the appropriate team (eg, cardiac surgeon, interventional cardiologist, or multidisciplinary team); and Model C, in which cardiologists refer patients with moderate-to-severe VHD to a clinic staffed by a cardiac surgeon and interventional cardiologist, with referral to a multidisciplinary team for further evaluation if needed.

Central Illustration

The Whole-Life Cycle Management System Patients who meet the eligibility criteria are reviewed by cardiologists and specialized-disease managers (SDMs), who develop individualized disease management plans and ensure long-term follow-up. The health care team utilizes a smart management platform to monitor patient progress and ensure effective control of the patient's journey. SDMs offer daily counseling, health management, and follow-up plans, leveraging smart health care tools to ensure continuity of care. Additionally, they are responsible for coordinating appointments with multidisciplinary teams and facilitating referrals and consultations for complex or high-risk patients. MDT = multidisciplinary team.

Figure 4

Comprehensive Referral System (A) The traditional access model for the hierarchical medical system has several limitations; (B) The new access model developed by West China Hospital promotes hierarchical diagnosis and treatment through a two-way referral process.

Figure 5

Integrated Outpatient System Valvular heart disease (VHD) patients are initially referred to a heart valve clinic staffed by cardiology specialists and specialized-disease managers, where they undergo an integrated examination following an echocardiogram to assess disease severity. Based on the initial findings and potential disease mechanisms, the cardiology specialist formulates a plan for further referrals and follow-up care. Specialized-disease managers are tasked with reminding patients with mild VHD to undergo regular reviews and coordinating follow-up examinations and treatment schedules for patients with moderate or more severe VHD, or those with postoperative valve dysfunction. Patients with primary VHD are referred to the “Professor Team Clinic,” while those with secondary VHD are directed to the “Multidisciplinary Team Clinic”. Additionally, patients with multiple comorbidities or those at high surgical risk may be referred to the “Multidisciplinary Team Clinic” for a comprehensive evaluation.

Figure 6

Lifelong Follow-Up and Active Interaction System In the active interaction system, patients can schedule follow-up appointments, pose questions online, and access health education resources. Specialized-disease managers assist with patient management, coordinate examination appointments, and update follow-up visit schedules through the intelligent management system. Physicians can ensure continuity of care by prescribing tests and reviewing medical records. SMS = short message service.

Figure 7

Time-Series Diagram Depicting the Whole Life-Cycle Management Time-series plot portraying the trajectory of a registered patient who underwent transfemoral transcatheter aortic valve replacement. The journey unfolds from the initial successful discharge, through an out-of-hospital emergency, readmission for treatment, and culminates with the final discharge home. The patient's overall well-being was favorable during the last follow-up, conducted 6 months post-discharge. SDM = Specialist-disease manager; TF-TAVR = transfemoral-transcatheter aortic valve replacement.