As many as 300,000 people in the UK are living with the potentially fatal cardiac condition aortic stenosis, of which nearly 100,000 may be unaware they are at risk because it often does not come with any symptoms.
A study by researchers from NHS England, the universities of Glasgow and Southampton, the University of Notre Dame Australia and other cardiologists and surgeons, concluded that, in 2019, 291,448 men and women aged 55 in the UK had aortic stenosis, or thickening or narrowing of the aortic valve.
Of these, 68% (199,000) had severe disease and, of these, some 92,000 – or nearly a third (32%) – had asymptomatic disease and therefore were at risk of their condition not being diagnosed or picked up.
When the condition becomes severe, it can be accompanied by symptoms such as breathlessness, tiredness and dizziness, but it can also remain without symptoms or may be overlooked because changes only come on very gradually over time.
This means it may not get spotted until it is too late, once someone has collapsed or is in hospital, or only if a GP happens to listen to a patient’s heart and then refers on for more specialist investigation. This is also the sort of warning sign that can be picked up by an occupational health practitioner during regular health screening.
Cardiac return to work
Worryingly, the researchers concluded that 59% of people with severe aortic stenosis may die within five years “without proactive management”.
Once diagnosed, aortic stenosis is usually monitored by a team of cardiologists and may mean a patient eventually needing to have the aortic valve replaced, either with a mechanical or tissue valve, and either via open-heart surgery or, increasingly commonly, through a keyhole procedure called transcatheter aortic valve implementation (TAVI).
Both are nowadays relatively standard surgical procedures, if still major surgery, and working-age patients will often return to work within six to eight weeks, although they may also need to follow a programme of cardic rehabilitation, access to which has become more limited during the pandemic.
Equally concerning, the researchers argued the extent of the condition within the community exceeded the NHS’ capacity to treat or manage it.
The study, published in the journal Open Heart, argued that: “Largely driven by an ageing post-war population cohort, we estimate that close to 300,000 adults are currently living with this potentially deadly condition at any one time.
“Of these, around two-thirds would potentially qualify for SAVR [surgical aortic valve replacement] or TAVI based on current guidelines. Critically, such an indicative burden is far greater than the current capacity within the NHS to screen, detect, triage and treat such cases.”