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New Guidelines for VHD

ountries and from different specialities, such as clinical, surgical and echocardiographical, also collaborated to write the VHD guidelines. One of the problems when treating VHD, or producing guidelines on its treatment, is the lack of evidence on best practice.

Prof Vahanian said: "When compared with other heart diseases, there are few trials in the field of VHD, and randomised trials are particularly scarce. Our guidelines are based on the evidence that exists and the consensus of all the experts who were involved in each step of the writing process. We hope that individual countries will recognise the quality of these guidelines and adopt them so that they become widely used throughout Europe for the benefit of patients."

The VHD guidelines deal with every aspect of treatment from patient evaluation through to surgery, other therapies and management during pregnancy. Prof Vahanian said that one important recommendation concerned the use of stress testing, when the function of the heart is evaluated while it is working harder as the patient exercises. "It is important that stress testing is used more often in order to ensure that patients who are not symptomatic receive the right treatment," he said.

The guidelines also point to the need to use echocardiography as the key technique to confirm a diagnosis of VHD. However, some countries provide better access to echocardiography facilities for patients than do other countries.

"Another important point concerns the treatment of elderly patients," said Prof Vahanian. "VHD occurs most frequently in the elderly, yet the Euro Heart Survey showed that many elderly patients were not even considered for surgery by physicians, for reasons that were often unjustified. So the guidelines stress the need for precise risk stratification before decisions are made about treatment for elderly patients.

"Increasingly we are seeing patients with VHD who have had surgery
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