New community heart valve clinics address healthcare gap

A pilot programme of community-based clinics has been set up in south London to more quickly identify and treat heart valve disease.

The clinics, in GP surgeries in Lambeth and Lewisham, are led by Guy’s and St Thomas’ and King’s College Hospital and have been established in areas where treatment rates for valve disease are known to be low.

Previous regional data shows Black and south Asian people in south London are less likely to have heart valve disease picked up and treated than white people. The diagnosis and treatment rates for women and people living in more deprived areas are also lower.

By making it easier and quicker for people to have tests in their local area, clinicians hope to close the healthcare gap.

In the UK it is estimated that around 3.5% of people over the age of 75 have a severe narrowing of their heart valves, and up to 1 in 20 of the population have a leaking heart valve – both of which are examples of heart disease. When this happens, people can experience breathlessness, chest pain, dizziness or blackouts. In these cases, they need urgent valve replacement or repair. Delays can cause irreversible damage to the heart or even be fatal.

However, many patients have heart valve disease but don’t realise it until their condition becomes serious.

During the 12-month trial, GPs in Lambeth, Southwark and Lewisham can refer patients with a suspected heart murmur to the community clinics for non-invasive tests including an ECG and echocardiogram.

If needed, those patients then get fast-tracked for a specialist appointment in hospital, with the whole process taking a few weeks rather than multiple months in the regular pathway.

In the first 6 months, advanced nurse practitioner Leoni Bryan and valve echo physiologist George Fisher screened 168 patients in the two clinics, with more than half (55%) from minority ethnic backgrounds. Of those screened, 57% had valve disease or other clinically significant findings, while more than a third (35%) were found to have at least moderate valve disease needing more treatment or monitoring.

Professor Ronak Rajani, consultant cardiologist and professor of cardiovascular imaging at Guy’s and St Thomas’, said: “We launched the community rapid access valve clinics to close the healthcare gap by putting the clinics in areas where treatment for valve disease is lower than expected.

“By bringing these clinics into the community, we are seeing people who might otherwise not know they had heart valve disease. We are diagnosing them quicker and offering them treatment if needed. This reduces health complications and saves the NHS money.”

Theresa Meli is currently waiting for surgery to her aortic valve, after she was diagnosed with severe aortic stenosis (narrowing of the aortic valve) through the trial programme.

In just 4 weeks, Theresa received scans and was seen by a cardiology consultant at St Thomas’, all of which would usually take 5 months.

Theresa, 78, who is Tunisian-Maltese and lives in Waterloo, south London, only had mild symptoms of tiredness, but her heart condition was picked up after she had a gall bladder operation earlier this year.

Theresa is now retired but was previously a cleaner with the House of Commons alongside caring for her family of 4 children, 9 grandchildren and 3 great-grandchildren. She said:

“I do get tired, but I’m hoping my operation will go well so I’m healthy enough to see all my great-grandchildren. I want to be around for another 20 years!”

Theresa’s daughter Louise Worley said: “It has been helpful that things have moved quickly – just a month from mum’s first appointment for this, to getting onto the waiting list for her operation.

“Mum doesn’t have English as a first language, but throughout the process, all the staff have taken their time to carefully explain what’s happening in a way she can understand. Everyone has been patient, and it’s been an amazing experience.”