Dr Joanna d'Arcy

Brief Outline: .

Background: Clinical Research Fellow, Department of Cardiovascular Medicine, University of Oxford and Cardiology Registrar, Oxford University Hospitals NHS Trust

Jo d'Arcy, Clinical Research Fellow, explains that heart valve disease most often affects the...

Valvular heart disease can affect any one of the heart’s four valves but it most commonly affects the two valves called the aortic valve and the mitral valve. It can cause one of two things on the whole. It can cause either leaking of the valve or it can cause narrowing of the valve. Both of these things make the heart work harder and make it less efficient. Over time that extra work for the heart can effectively tire the heart out and like any muscle which is working too hard over a long period of time it begins to work less efficiently and it begins to fail. So what we aim to do with the treatment of valve disease is to intervene before the heart muscle becomes too tired out and before that element of heart failure has occurred.

Heart valve disease is not well understood. We need to know more about whether we can identify...

So this is an important area because valve disease is relatively less well understood compared with other areas of heart disease and we don’t know how common it is or the time period in which it is going to progress. The difficulty with valve disease is that unlike many other diseases it may have existed for some time before patients get symptoms. What is important to make sure is that any treatment that we do for the valve disease occurs before there is damage to the heart that can’t be reversed with treatment such as surgery. The difficulty being that symptoms may occur after that irreversible damage has occurred. So what we would hope to be able to look at is whether we can identify more closely when people will need treatment before there is irreversible damage and make sure that treatment occurs at that time, rather than after the damage has been done.

Jo explains that the research programme is studying how common heart valve disease is, and also...

We are trying to find out how common this valve disease is, exactly what types of valve disease we are looking at, what is most common and what is going to be most important in terms of requiring treatment, and also over what time period it might be that people need treatment. So we are aiming to capture the number of people with valve disease but also looking at being able to find out whether people are happy to be examined for valve disease in terms of screening, whether it upsets people or whether actually they are quite comfortable with it and feel that it is worthwhile attending for, and also developing groups of people with valve disease that we can study in more detail over time. 

 

So people who are asked to participate are those who are aged over sixty five who are registered with the General Practices that are participating in the study and who have not previously been told that they have valve disease. 

 

The research team will monitor anyone who is found to have the condition over several years to...

The majority of valve disease that we are seeing is very mild disease which clinically doesn’t require any further monitoring or follow-up except we may contact them as part of the study in the future. For those people where clearly there is more to be done, or it may be that they’ve got slightly more severe valve disease, then we would recommend to the patients and to their GP that they should be followed up in clinic. Again it depends what type of valve disease it is that they have but in line with current guidelines on the management of valve disease. But for a lot of people with mild valve disease they would only need to come to that second visit. 

 

We will be following people over time using various different national databases. Obviously all with patients consent then we can follow them up and see whether they’re, they need to attend their hospital more frequently. Whether being diagnosed with valve disease is associated with other types of disease affecting the heart or whether in fact there is no difference between the majority of our patients and those who aren’t round to have valve disease.

 

Jo d'Arcy, Clinical Research Fellow, explains that the first screening appointment involves an...

So people who are asked to participate are those who are aged over sixty five who are registered with the General Practices that are participating in the study and who have not previously been told that they have valve disease. 

 

Those people are being invited to attend their General Practitioners for their first study visit. What that then involves is a study visit that is about forty five minutes to an hour long during which time we ask them a few background questions about their past health, particularly things that might affect the health of their heart, such as their blood pressure and whether they have had problems with angina, that kind of thing, and we then undertake a scan of their heart, an ultrasound scan of their heart which is called an echocardiogram, and which takes about twenty – twenty five minutes. And allows us to have a good look at the structure and pump function of the heart, as well as looking at the valves in particular to look for any narrowings or leakage that might be there. What we do is we give people their preliminary results actually as they attend their first study visit so if their scan is normal we are able to reassure them at that stage and thank them very much for their participation and give them a copy of their results as well.