KEYNOTE: The impact of heart valve disease on patient lives, economy and society: a global perspective

Abstract

The heart valve disease (HVD) epidemic is an expanding global health challenge. In  high-income countries, degenerative HVD in older adults predominates, with ample access to surgical and transcatheter valve replacement. In low- and middle-income countries rheumatic heart disease (RHD) particularly affects children and young adults (women>men), with limited access to healthcare including appropriate diagnostic care and surgical therapies.

From a clinical perspective, HVD poses multiple challenges: optimizing diagnosis, tailoring treatment to the individual patient (timing of intervention and prosthetic valve choice), and minimizing the hazards of valve-related complications to optimize life expectancy. The quest for the perfect valve substitute continues.

From a patient perspective, HVD has a profound impact on quality of life, that can be dramatically improved with timely intervention, provided that valve selection is tailored to individual patient needs, values and goals in life.  Women remain understudied in HVD including RHD, present later in the disease process, with a different risk profile compared to men, and are more likely to undergo valve replacement versus repair. Importantly, pregnancy in women with uncorrected and corrected HVD carries a markedly increased risk of maternal mortality and morbidity.

From an economic perspective, HVD results in high direct and healthcare expenditures, and significant productivity losses. As women are more likely to carry informal caregiver roles, HVD causes gendered economic disparities to increase. Despite its global burden, HVD remains underprioritized within global noncommunicable disease initiatives.

From a societal perspective, it is evident that HVD is closely linked to global challenges such as poverty, gender inequality, and equitable access to healthcare and education. A global equity-focused transdisciplinary effort is needed to mitigate preventable mortality,  improve clinical outcomes and provide better lives for all people living with HVD, particularly in underserved populations.