Abstract 2663: How Do Cardiologists and Cardiothoracic Surgeons Treat Asymptomatic Mitral Regurgitation in Clinical Practice? An International Survey
Background: Severe mitral regurgitation (MR) is known to be associated with adverse clinical outcomes. Thus, consensus-derived, evidence-based practice standards (e.g., ACC/AHA Guidelines for Management of Valvular Heart Disease) have been published. Yet, no data exist to describe whether physicians follow such standards in clinical practice for asymptomatic pts with MR.
Methods: A random sample of cardiovascular specialists were surveyed by email and asked to complete 26 items that encompassed MR-related practice patterns.
Results: 1035 physicians completed the survey (68% response rate) and the sample included adult cardiologists (95%) and cardiac surgeons (5%) who practice in the USA (84%), Canada (6%), and other nations (10%). When asked ``Do you refer asymptomatic patients with severe MR and normal LV function for MV repair?”, 28% responded yes/almost always, and 11% responded no/ rarely. There was geographic & specialty-dependent variation in practice (Table⇓). Patient referral for mitral surgery was based on risk markers, such as atrial fibrillation (18%) and pulmonary hypertension (17%) and anatomic factors (e.g., flail valve, 18%) and clinical variables (e.g., increased likelihood of repair, 19%). Most physicians (65%) use medications to delay progression of MR, with ACE-inhibitors utilized by 57%. Isolated posterior prolapse repair was repaired successfully >85% at their hospital by 61% (60% for cardiologists vs. 82% for surgeons, p=0.004). 28% of respondents almost always quantitate MR using effective regurgitant orifice area, while 30% rarely or never do so.
Conclusions: Cardiologists frequently refer asymptomatic MR patients for mitral reparative surgery, but referral is often prompted by factors beyond those included in current guidelines. Practice patterns vary by physician type and by geographical location. Medications are frequently used to treat asymptomatic individuals with MR, in the absence of documented evidence of efficacy.