Valvular heart disease: how pharmacists can help

More than 250,000 Australians have faulty heart valves and are at risk of serious complications, including heart failure, stroke and death – yet don’t know it. Australian Pharmacist spoke to an expert about the symptoms pharmacists can help spot in patients.

According to a new white paper released this week, Our hidden ageing – time to listen to the heart, more than 500,000 Australians have valvular heart disease, including narrowing (stenosis) and leaking (regurgitation).

Developed by experts at Melbourne’s Baker Heart and Diabetes Institute, it also revealed that a quarter of a million people have undiagnosed valvular heart disease. The number of undiagnosed cases is expected to climb over the next 3 decades, reaching 435,000 by 2051.

Aortic valve disease is the most frequent cause of severe valvular heart disease. The most common manifestation of this is aortic stenosis, or a narrowing of the aortic valve. 

Cases of aortic stenosis are expected to climb, the paper stated, to 200,000 by 2031 and 266,000 by 2051.

‘The benefits of living in a first world country means that many of us will survive to a “ripe old age”, so we are living long enough to develop conditions such as aortic stenosis,’ cardiologist and Interim Director of Cardiology at Canberra Hospital Dr Peter French told AP.

‘People with disorders like this may place a significant burden on the healthcare system in that they are constantly in and out of hospital, their quality of life is poor and their contribution to society is limited.’

‘The symptoms … may either be quite subtle, or often at times misinterpreted, especially by the older patient, as just a sign of ageing.’

Hidden symptoms of valvular heart disease

Although serious, valvular heart disease is increasingly treatable through procedures including non-surgical valve replacement – provided you know it’s there. But it is not always easy to detect.

‘The symptoms … may either be quite subtle, or often at times misinterpreted, especially by the older patient, as just a sign of ageing,’ Dr French said.

‘With coronary artery disease, the symptoms of angina are often chest pain/discomfort in the chest that restricts the person in normal everyday activities. The symptoms of valvular heart disease may not be as straightforward, especially in the older age groups.’

For example, patients may experience shortness of breath, which limits their normal physical activity. However this may be seen simply as a sign of ageing and accepted as something about which nothing can be done. 

‘Therefore, they may not necessarily mention this symptom to their general practitioner when, and if, they see them, for routine medical reviews,’ Dr French said. 

‘Other more sinister symptoms, especially in relation to blockage of the aortic valve, [include] dizziness on exertion or, in its most extreme form, actual loss of consciousness on exertion.’

Signs and symptoms of valvular heart disease

Source: Our hidden ageing – time to listen to the heart

As medical professionals who often see the same patients regularly, community pharmacists often pick up on potential symptoms during discussions when supplying other medicines.

‘Talking to the patient about their current symptoms and how the symptoms are impacting upon their quality of life can give valuable insight into the underlying disorder,’ Dr French said.

‘Certainly asking the patient, “How are you going, how’s life in general, are there any symptoms that are restricting you and what you can do?” can give a clue as to the possibility of underlying significant valvular heart disease.’

If a pharmacist suspects a patient may have an underlying condition, they should encourage the patient to discuss the symptoms, and a plan of specific questions to ask, with their doctor.

‘Emphasising the need for the doctor to listen to the heart with a stethoscope can be exceedingly helpful,’ Dr French said.

‘All too often, patients may go to see their doctor for a regular check-up of their blood pressure or other conditions, and may not necessarily have their general practitioner listen to their heart with a stethoscope.’

This is particularly important as significant valvular heart disease is often associated with distinct, audible murmurs, which can be detected through the proper use of a stethoscope, Dr French added. 

Greater awareness of valvular heart disease needed

When 71-year-old Phil Holmes started to feel fatigued and short of breath while doing push ups for a work fundraiser in 2019, he never considered it was heart-related.

‘Emphasising the need for the doctor to listen to the heart with a stethoscope can be exceedingly helpful.’

Prior to the pandemic, his job required weekly travel, and he enjoyed spending his free time in the gym. Aside from a health scare in 1997, when he was told to improve his health and fitness, the grandfather and head of insurance at a leading glass supplier had never had any serious heart concerns.

‘I found it hard to complete my fitness workouts and felt a lot more tired than usual,’ he said. 

‘My trainer noticed as well. It was very out of character for me … I thought it was just age and fatigue.’

However, a visit to a GP and then a heart specialist confirmed he had heart valve disease.

‘After overhauling my diet and lifestyle in 1997, I honestly never thought I would be at risk,’ Mr Holmes said. 

‘I believe all Australians aged 65 and over should be well informed about heart valve disease and the various treatment options available.’

Lead author of the Baker Heart and Diabetes Institute white paper, cardiologist Professor Tom Marwick agreed, and said more needed to be done to raise awareness among the public and health professionals about the disease. 

‘It is important to keep in mind that the common symptoms of heart valve disease –especially exercise intolerance – are often misattributed to “old age”,’ he said.

‘We need increased awareness through marketing campaigns; strategies to upskill and support primary care; financial support for the use of emerging technologies; health service design, including improved access to echocardiography; funding to improve access and equity to interventions; and development of national heart valve disease guidelines.

‘We must all keep in mind that valvular heart disease can go unrecognised, undiagnosed, and untreated, and the complications can be devastating.’

Read the Our hidden ageing – time to listen to the heart white paper here.