The aged care community can help detect one of the most common heart conditions among the elderly, writes Associate Professor David Muller.
Aortic Stenosis (AS) is one of the most prevalent and serious aortic valve conditions impacting elderly people in Australia. An estimated one in eight Australians aged 75 years old and over is currently living with it.
However, AS is hard to detect and diagnose, and the condition can worsen over time, without the patient knowing. In addition, awareness of the condition has fallen short among seniors, the general public, and the medical community.
In most cases, the best treatment is an aortic valve replacement, but it is believed that more than 40 per cent of severe AS patients currently do not have their valves replaced.
It is time to act. Indeed, up to 50 per cent of patients with severe AS will die within an average of two years if they are treated only medically. We need to increase awareness of the condition throughout the country, develop the habit to look out for its symptoms in order to detect it at earlier stages, and then to act appropriately.
Aged care professionals are in a prime position to do this, and play a pivotal role in minimising the toll of aortic stenosis in Australia.
Challenges with identifying AS
Aortic Stenosis is a degenerative condition that results in calcium deposition on the valve leaflets, thickening and hardening them. This calcification results in narrowing of the valve, which forces the heart to work harder.
Typically, the patient’s health deteriorates progressively over time, without strong signals alerting them that something is wrong, at least until the severe stages. The symptoms, which include shortness of breath, difficulty in achieving light physical efforts, dizziness, or tiredness, can also be confused with signs of ageing, and anyone not aware of AS would not naturally think there is a cardiac origin to them.
Aortic Stenosis can be asymptomatic until very late, and patients in seemingly good condition could already have severe Aortic Stenosis that requires treatment. Regularly listening to the heart is essential, and may help detect signs of valve disease.
These factors, combined with a relatively low awareness of the condition, are the origins of misdiagnosis or late detection, when treatment and monitoring should ideally start as early as possible.
Aged care community’s role
Aged care workers can help ignite change in the fight against AS. Their knowledge of the initial health condition of a patient, and daily contact with them, is an amazing opportunity to observe and identify the smallest signs of deterioration while patients go about their daily routines.
Most other healthcare specialists are only seeing patients sporadically, and not always in the best conditions to detect the symptoms.
Tiredness that lasts for several days or weeks, unusual breathlessness during a walk, or dizziness while exercising should be red flags, and should not automatically be attributed to ageing.
It is important to raise awareness of this with patients, and encourage them to take these symptoms seriously. Although senior people may have difficulty communicating openly with their caregivers about health issues, they should be asked about these symptoms, and be aware that the condition can now be treated.
Any professional who identifies symptoms in a patient under their care should connect them with a general practitioner who will then decide the best course of action.
One of the critical ingredients to mitigating the impact of AS in Australia is a timely referral and treatment, and the aged care community has the opportunity to help increase the rate of early diagnosis.
Treatment options, post-treatment care
When a case of AS becomes very severe, and the valves don’t operate efficiently anymore, they need to be replaced. Open-heart surgery is the primary option in most cases, but is a risky option for frail patients, or those with multiple potential co-morbidities.
It can be a daunting prospect for an elderly person. However, with medical advancements, a less-invasive procedure for aortic valve replacement exists, called a Transcatheter Aortic Valve Implantation (TAVI).
TAVI is an alternative to open heart surgery, in which the artificial valve is implanted in the body through a small incision in the groin, and then is directed to the heart through the pelvic arteries, to replace the damaged valve.
The procedure has various proven benefits for patients, the most obvious one being a minimally invasive solution, and reduced anxiety for senior patients.
Those undergoing a TAVI stay in hospital for an average of three days, compared to seven with surgery. And patients have reported significant improvement to health status and quality of life as early as one month after the procedure.
Finally, limited post-treatment follow-up is required, potentially reducing the burden on aged care teams when the patient is discharged.
The awareness of a less invasive procedure may help convince elderly patients to act on potential symptoms and start engaging in a detection process.
AS has long affected our elderly population and a common effort in discussing the condition on multiple fronts will go a long way towards mitigating its impact. Awareness of the condition and its treatment options among aged care workers will help us in this cause.
Associate Professor David Muller is an Interventional Cardiologist at St Vincent’s Hospital, Sydney.
This article first appeared in Australian Ageing Agenda magazine (Sep-Oct 2020).