From the Guidelines
The 2014 American Heart Association (AHA)/American College of Cardiology (ACC) guideline for the management of patients with valvular heart disease is currently obsolete.
Key Updates
- The field of valvular heart disease is rapidly progressing, with new knowledge of the natural history of patients with valve disease, advances in diagnostic imaging, and improvements in catheter-based and surgical interventions 1.
- Several randomized controlled trials (RCTs) have been published since the 2014 VHD guideline, particularly with regard to the outcomes of interventions, leading to updates in recommendations for transcatheter aortic valve replacement (TAVR), surgical management of primary and secondary mitral regurgitation (MR), and management of patients with valve prostheses 1.
- A new guideline was released in 2020, which replaces the 2014 guideline and the 2017 focused update, providing updated recommendations for the diagnosis and management of patients with valvular heart disease, including the use of novel oral anticoagulants and transcatheter valve interventions 1.
Clinical Implications
- Clinicians should consult the 2020 ACC/AHA guideline for the management of patients with valvular heart disease for optimal management, as it provides concise, evidence-based, contemporary recommendations with supporting data 1.
- The new guideline includes updated recommendations for the treatment of various valvular heart diseases, such as aortic stenosis, mitral regurgitation, and tricuspid valve disease, with a focus on earlier intervention and the use of medications like beta blockers and ACE inhibitors for longer durations.
- The guideline also includes algorithms to guide clinicians in the screening, diagnosis, and management of patients with valvular heart disease, making it a valuable resource for clinicians 1.
From the Research
Guideline Updates and Relevance
- The 2014 American Heart Association (AHA)/American College of Cardiology (ACC) guideline for the management of patients with valvular heart disease has undergone updates and revisions, as seen in the 2017 focused update paper 2, 3.
- The development of Appropriate Use Criteria (AUC) for the treatment of patients with severe aortic stenosis in 2017 indicates a continuous effort to refine and improve guidelines for valvular heart disease management 2, 3.
- A comparison of recent updates to the ACC/AHA and ESC guidelines for the management of valvular heart disease highlights similarities and differences, suggesting that the field is evolving with new recommendations and advancements in diagnosis and treatment 4.
Obsolescence of the 2014 Guideline
- The 2014 AHA/ACC guideline was used as a primary guiding reference in developing the 2017 AUC for the treatment of patients with severe aortic stenosis, indicating that it was still considered relevant at that time 2, 3.
- However, the presence of updates and new guidelines, such as the 2017 focused update and the comparison of recent updates to the ACC/AHA and ESC guidelines, suggests that the 2014 guideline may not be entirely current or comprehensive in its recommendations 2, 4, 3.
- The fact that there have been significant revisions and new recommendations in the management of valvular heart disease, including the use of percutaneous treatments and the indications for intervention in asymptomatic VHD, implies that the 2014 guideline may be outdated in certain aspects 4.