title: Practice gaps in the care of mitral valve regurgitation: Insights from the American College of Cardiology mitral regurgitation gap analysis and advisory panel.
abstract: BACKGROUND
  The revised 2014 American College of Cardiology (ACC)/American Heart Association valvular heart disease guidelines provide evidenced-based recommendations for the management of mitral regurgitation (MR). However, knowledge gaps related to our evolving understanding of critical MR concepts may impede their implementation.
  
  
  METHODS
  The ACC conducted a multifaceted needs assessment to characterize gaps, practice patterns, and perceptions related to the diagnosis and treatment of MR. A key project element was a set of surveys distributed to primary care and cardiovascular physicians (cardiologists and cardiothoracic surgeons). Survey and other gap analysis findings were presented to a panel of 10 expert advisors from specialties of general cardiology, cardiac imaging, interventional cardiology, and cardiac surgeons with expertise in valvular heart disease, especially MR, and cardiovascular education. The panel was charged with assessing the relative importance and potential means of remedying identified gaps to improve care for patients with MR.
  
  
  RESULTS
  The survey results identified several knowledge and practice gaps that may limit implementation of evidence-based recommendations for MR care. Specifically, half of primary care physicians reported uncertainty regarding timing of intervention for patients with severe primary or functional MR. Physicians in all groups reported that quantitative indices of MR severity were frequently not reported in clinical echocardiographic interpretations, and that these measurements were not consistently reviewed when provided in reports. In the treatment of MR, nearly 30% of primary care physician and general cardiologists did not know the volume of mitral valve repair surgeries by their reference cardiac surgeons and did not have a standard source to obtain this information. After review of the survey results, the expert panel summarized practice gaps into 4 thematic areas and offered proposals to address deficiencies and promote better alignment with the 2014 ACC/American Heart Association valvular disease guidelines.
  
  
  CONCLUSIONS
  Important knowledge and skill gaps exist that may impede optimal care of the patient with MR. Focused educational and practice interventions should be developed to reduce these gaps.
authors: Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: a.wang@duke.edu.
authors: Andrew
authors: A
authors: Wang
authors: Department of Medicine, Baylor Heart and Vascular Hospital and the Heart Hospital Baylor Plano, Houston, TX.
authors: Paul
authors: P
authors: Grayburn
authors: Education Needs Assessment & Research, American College of Cardiology, Washington, DC.
authors: Jill A
authors: JA
authors: Foster
authors: Cardiovascular Imaging, Houston Methodist Hospital, Houston, TX.
authors: Marti L
authors: ML
authors: McCulloch
authors: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors: Vinay
authors: V
authors: Badhwar
authors: Department of Surgery, University of Maryland Medical Center, Baltimore, MD.
authors: James S
authors: JS
authors: Gammie
authors: Department of Medicine, Dartmouth-Hitchcock Medical Center, New Lebanon, NH.
authors: Salvatore P
authors: SP
authors: Costa
authors: Department of Medicine, University of Maryland Medical Center, Baltimore, MD.
authors: Robert Michael
authors: RM
authors: Benitez
authors: Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC.
authors: Michael J
authors: MJ
authors: Rinaldi
authors: Department of Surgery, Emory University Medical Center, Atlanta, GA.
authors: Vinod H
authors: VH
authors: Thourani
authors: Valvular and Structural Heart Disease, Piedmont Healthcare, Atlanta, GA.
authors: Randolph P
authors: RP
authors: Martin
mesh_terms: D026683:Advisory Committees; D000572:American Heart Association; D002309:Cardiology / Q000379:methods*; D019468:Disease Management; D019983:Guideline Adherence; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000628:therapy*; D017410:Practice Guidelines as Topic; D014481:United States