Algorithm for primary care physicians in the management of valvular heart disease in India

In India, the burden of valvular heart disease (VHD) is high due to rheumatic heart disease (RHD). Factors like poverty, overcrowded dwellings, under-nutrition, cultural constraints, and suboptimal medical care contribute to the high prevalence of RHD. The diagnosis of VHD is a problem in routine practice and many cases are either missed in early stages. Also, late identification/ referral of complications in post valvular surgery patients of VHD by physicians working in the periphery to a large extent but not limited to periphery only. Hence, the need of the hour is to enhance the knowledge of Primary care physicians and create an easy-to-use algorithm for physicians to facilitate early identification and diagnosis of VHD and complications in post cardiac surgery patients for timely referral to reduce mortality and morbidity associated with VHD. The algorithm will act as a tool to recognize early signs and symptoms of VHD for early diagnosis of VHD & its management. The algorithm will also facilitate early referral to specialist and identification of post-operative complications in patients who have undergone surgery for VHD. Valvular heart disease patients after prosthetic valve implantation are at a risk of thrombo-embolic and therefore require lifelong follow up and anticoagulant therapy in order to alleviate morbidity and mortality which also needs to be cascaded down to the primary care physicians based on evidence-based recommendations on anti-coagulation management. This easy-to-use guide/algorithm will help physicians better their clinical practice in India, ultimately benefiting the patient outcomes.