title: ESC Working Group on Valvular Heart Disease position paper--heart valve clinics: organization, structure, and experiences.
abstract: BACKGROUND
  With an increasing prevalence of patients with valvular heart disease (VHD), a dedicated management approach is needed. The challenges encountered are manifold and include appropriate diagnosis and quantification of valve lesion, organization of adequate follow-up, and making the right management decisions, in particular with regard to the timing and choice of interventions. Data from the Euro Heart Survey have shown a substantial discrepancy between guidelines and clinical practice in the field of VHD and many patients are denied surgery despite having clear indications. The concept of heart valve clinics (HVCs) is increasingly recognized as the way to proceed. At the same time, very few centres have developed such expertise, indicating that specific recommendations for the initial development and subsequent operating requirements of an HVC are needed.
  
  
  OBJECTIVE
  The aim of this position paper is to provide insights into the rationale, organization, structure, and expertise needed to establish and operate an HVC. Although the main goal is to improve the clinical management of patients with VHD, the impact of HVCs on education is of particular importance: larger patient volumes foster the required expertise among more senior physicians but are also fundamental for training new cardiologists, medical students, and nurses. Additional benefits arise from research opportunities resulting from such an organized structure and the delivery of standardized care protocols.
  
  
  CONCLUSIONS
  The growing volume of patients with VHD, their changing characteristics, and the growing technological opportunities of refined diagnosis and treatment in addition to the potential dismal prognosis if overlooked mandate specialized evaluation and care by dedicated physicians working in a specialized environment that is called the HVC.
authors.affiliation: GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, Liège, Belgium. plancellotti@chu.ulg.ac.be
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosenhek
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Otto
authors.forename: Pilar
authors.initials: P
authors.lastname: Tornos
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.forename: Bernard
authors.initials: B
authors.lastname: Prendergast
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Luc A
authors.initials: LA
authors.lastname: Piérard
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D001071:Appointments and Schedules; D057791:Cardiac Imaging Techniques / Q000379:methods; D002309:Cardiology / Q000458:organization & administration; D003325:Coronary Care Units / Q000458:organization & administration*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D009937:Organizational Objectives; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic / Q000379:methods; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000458:organization & administration; D012017:Referral and Consultation
keywords: Healthcare organization; Heart valve clinic; Management; Valvular heart disease