The new guidance outlines how adults with heart valve disease should be investigated and managed

Human heart

NICE has published new guidance on the investigation and management of heart valve disease presenting in adults.

NICE Guideline (NG) 208 aims to improve the quality of life and survival of people with heart valve disease through timely diagnosis and appropriate intervention. It updates and replaces the recommendations on valve surgery and percutaneous intervention in the NICE Clinical Guideline on acute heart failure published in October 2014.

This guideline includes recommendations on:

  • referral for echocardiography and specialist assessment
  • pharmacological management
  • indications for interventions
  • interventions
  • monitoring after an intervention.

The recommendations also include advice on the management of pregnant women and women considering pregnancy.

NICE suggests that a beta-blocker is considered for the pharmacological management of adults with moderate-to-severe mitral stenosis and heart failure. When adults with heart valve conditions and heart failure also have left ventricular dysfunction, NG208 advises clinicians refer to NG106 on chronic heart failure in adults.

In addition, the guideline recommends that patients with symptomatic severe heart valve disease are offered an intervention, with severity of valve disease defined in line with the British Society of Echocardiography guidelines on the British Heart Foundation’s website.

NICE says: ‘Severe symptomatic heart valve disease has a poor prognosis and there is no treatment for the symptoms other than an intervention on the valve. Because of this, the committee recommended that an intervention should be offered to this group.’

Other indications for interventions are asymptomatic severe aortic regurgitation, asymptomatic severe primary mitral regurgitation, and specified categories of aortic stenosis.


Lead image: magicmine/

Image 1: magicmine/