Introduction
Degenerative aortic stenosis (AS) is a chronic, progressive and life-threatening disease and can present as aortic sclerosis, without obstruction to ventricular outflow, at one end of the spectrum to severe AS at the other.1 Patients with AS have a long time period during which severity (degree of narrowing of the aortic orifice with an associated increase in transvalvular pressure gradients) increases without symptoms. However, during this time, patient risk gradually increases and an estimated 50% of patients with mild or moderate AS have progressive valve calcification leading to haemodynamically severe AS.1 2 Once the gradient across the valve has increased beyond 20 mm Hg, which is the cut-off between mild and moderate AS in all major current guidelines,3 4 patients may become symptomatic, experience progressive disability and the mortality risk increases such that half of all patients will die within 2–5 years without treatment.2 5 6 Aortic valve replacement (AVR) is the definitive treatment for patients with AS.3 However, the diagnosis of AS remains challenging, despite it being the most common valvular heart disease (VHD) in the Western world.7
Diagnosis of AS needs to be established early when the asymptomatic patient is well, decompensation has not taken place and intervention can be planned. Recent data, however, confirm that diagnosis of AS-affected patients is often missed,8 and by the time of referral for intervention ~80% have severe symptoms and frequently impaired left ventricular (LV) function.9 10 Symptoms of AS are difficult to interpret as they are non-specific and often attributed to various other pathologies in a predominantly elderly population.11 Furthermore, cardiac auscultation is not routinely performed by general practitioners (GPs) and lacks sensitivity.11 Echocardiography is the definitive test of choice for diagnosis and severity assessment of AS, but is a scarce and underused resource in the UK.12 Traditionally, transthoracic echocardiography has been performed in hospitals due to the use of large machines, limited portability and requirement for detailed skills. Technical advances have led to gradual miniaturisation and point-of-care echocardiography devices are now widely available and could be used for VHD screening.13 Recent preliminary data have shown the use of handheld devices to screen for AS in the community.14
The purpose of this study was to: (1) determine the feasibility of AS screening in a community population aged >65 years attending influenza vaccination using target auscultation and 2D echocardiography; (2) establish the detection rate of AS and clinical follow-up of subjects with a suspected AS diagnosis to evaluate diagnosis/treatment status after 3 months. This article is presented in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology reporting checklist.