Cardiology
Calls to tackle delays in HVD pathway
Wil Woan, Executive Director at the charity, Heart Valve Voice, warns that diagnosis and treatment delays are common for patients with heart valve disease, leading to emergency admissions, complex procedures and longer recovery times.
Heart valve disease (HVD) affects over 1.5 million people in the UK, with prevalence rising sharply in older age groups.1
Aortic stenosis and mitral
regurgitation are the most common forms, and both can be fatal if left untreated. Yet despite clear clinical pathways and proven interventions, too many patients are diagnosed late, treated as emergencies instead of elective patients and face avoidable harm. New data from Heart Valve Voice’s 2025
Patient Experience Survey reveals troubling diagnosis delays and treatment delays are common, particularly for patients in the most deprived areas who are three times more likely to experience diagnostic delays than those in the least deprived. Across the board, nearly 40% of patients report delays in accessing treatment after diagnosis.2 What are the systemic causes of delay? From
low awareness to overstretched services, Heart Valve Voice is calling for targeted investment in HVD pathways to prevent emergency admissions, reduce complexity and improve outcomes.
Murmurs missed in primary care Before diagnosis, 37% of patients had never heard of heart valve disease, and 32% were unaware of its symptoms, such as breathlessness, fatigue, dizziness, and chest pain. Many people don’t know anything about heart valve disease and symptoms creep in slowly - it’s easy to brush them off until the person is seriously ill and ends up in A&E.2 Even when patients do seek help,
overstretched GPs may miss the opportunity to detect Heart Valve Disease. Some GP practices in deprived areas have over 10,000 patients per full-time GP – that’s nearly five times the national average and ten times more than mainland Europe.3 What this means in practice is that patients struggle to get an appointment and, when they do, the consultation might be rushed. The symptoms may be mistaken for normal ageing, asthma or anxiety, when time pressures and competing priorities can obscure the time
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for a simple but vital cardiac assessment – a stethoscope check. But if a murmur is missed, then so is the opportunity to refer promptly.
Slow pathways from echo to intervention Once valve disease is suspected, diagnosis typically involves an echocardiogram, a non- invasive ultrasound scan of the heart. If disease is confirmed, patients are assessed for how soon they may need either surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), depending on age, frailty and other comorbidities. However, clinical decision-making often relies
heavily on echo readouts, which may not reflect the full picture. Highly symptomatic patients can be deprioritised if their echo doesn’t show severe stenosis, despite struggling with daily activities or experiencing frequent hospital visits. Patient-reported outcomes must be considered alongside imaging. We recently
conducted a survey of over 300 Valve Patients and one respondent said: “My clinician seemed to be waiting until I suffered a severe cardiac problem.” This reactive approach leads to emergency admissions, complex procedures and longer recovery times – placing strain on both patients and the NHS.
Elective vs non-elective: the cost of delay Heart Valve Voice’s 2025 Patient survey shows that 16% of patients were admitted and treated as emergency cases, while 18% were admitted as emergencies but still faced treatment delays. These patients often endure: l Frequent GP appointments. l Multiple A&E visits. l Emergency ambulance transport. l Extended time off work. l Emotional distress and poor mental health.
In contrast, elective patients typically experience smoother pathways, shorter hospital stays, and
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