Ran Zechao, Wang Yuqiang, Cao Tingqian, He Siyu, Li Xiaoting, Guo Yingqiang
Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, China.
Department of Cardiovascular Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
BMJ Open. 2025 Jun 18;15(6):e096538. doi: 10.1136/bmjopen-2024-096538.
To evaluate the impact of heart valve clinics (HVCs) versus standard of care (SOC) on disease detection, timing of intervention and clinical outcomes in patients with valvular heart disease (VHD).
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42024518787).
PubMed, Embase, Web of Science, Scopus and the Cochrane Library from inception to 1 May 2025.
Randomised controlled trials or cohort studies comparing patients managed in HVCs with those receiving SOC, and reporting on outcomes such as mortality, cardiac events, time to symptom reporting or symptom severity. Studies were excluded if they lacked detailed HVC protocols, single-arm designs or were published as abstracts only.
Two reviewers independently screened titles, abstracts and full texts, with discrepancies resolved by a senior adjudicator. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. Meta-analysis was not conducted due to heterogeneity among studies.
Three high-quality prospective cohort studies (N=1082) were included. Two studies reported mortality and cardiac events: one, a before-and-after controlled trial (n=382), recorded 11 deaths in the HVC group; the other reported 4 deaths in the HVC group (n=156) versus 17 deaths in the SOC group (n=156) (p<0.05). Additionally, two studies found that HVCs significantly reduced the interval between symptom onset and reporting (p<0.05), as well as the proportion of patients presenting with severe symptoms (defined as New York Heart Association (NYHA) class or Canadian Cardiovascular Society (CCS) class ≥III).
HVCs facilitate stratified and precise management of the whole-life cycle of patients with VHD, enhancing early detection and referral, and leading to reduced mortality and major cardiac events compared with SOC.
评估心脏瓣膜诊所（HVCs）与标准治疗（SOC）相比，对瓣膜性心脏病（VHD）患者疾病检测、干预时机和临床结局的影响。
按照系统评价和Meta分析的首选报告项目指南进行系统评价，并在国际前瞻性系统评价注册库（PROSPERO）中注册（CRD42024518787）。
从创刊至2025年5月1日的PubMed、Embase、科学引文索引、Scopus和考克兰图书馆。
比较在HVCs接受治疗的患者与接受SOC治疗的患者的随机对照试验或队列研究，并报告死亡率、心脏事件、症状报告时间或症状严重程度等结局。如果研究缺乏详细的HVC方案、单臂设计或仅以摘要形式发表，则予以排除。
两名评审员独立筛选标题、摘要和全文，分歧由一名高级裁决者解决。采用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。由于研究之间存在异质性，未进行Meta分析。
纳入三项高质量前瞻性队列研究（N = 1082）。两项研究报告了死亡率和心脏事件：一项前后对照试验（n = 382）记录HVC组有11例死亡；另一项研究报告HVC组有4例死亡（n = 156），而SOC组有17例死亡（n = 156）（p<0.05）。此外，两项研究发现，HVCs显著缩短了症状出现与报告之间的间隔（p<0.05），以及出现严重症状（定义为纽约心脏协会（NYHA）分级或加拿大心血管学会（CCS）分级≥III级）的患者比例。
与SOC相比，HVCs有助于对VHD患者的全生命周期进行分层和精准管理，加强早期检测和转诊，并降低死亡率和主要心脏事件。
