Structural heart disease (SHD) refers to conditions affecting the heart's structure. It primarily affects older people and can be debilitating or deadly if not treated early. The document discusses barriers to optimal SHD detection and treatment in Europe, including lack of awareness, under-detection by doctors, ageism in diagnosis, and unequal access to care. It recommends increasing public and doctor awareness, improving early detection through guidelines and technology, ensuring high-quality treatment, addressing ageism, and collecting better SHD data to understand inequalities and guide policy.

1. The invisible epidemic:
Rethinking the detection and
treatment of structural heart
disease in Europe
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2. Welcome from Chair
Professor Huon Gray, retired National
Clinical Director for Heart Disease at NHS
England
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3. Report launch: Presentation
of key research findings
Arun Himawan, Research Fellow, ILC
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4. About ILC
We are the UK’s specialist think
tank on the impact of longevity
on society, and what happens
next.
We are one of the founding
members of the ILC Global
Alliance, an international
network on longevity with
members across 16 countries.

5. Context
• Structural heart disease (SHD) is a set of cardiovascular conditions that affect the
structure of the valves, atria, ventricles and blood vessels in the heart.
• Valvular heart disease (VHD) comprises a large proportion of SHD cases.
• SHD primarily affects older people.
• If not diagnosed and treated early enough, SHD can be both debilitating and deadly
for patients.
• Fortunately, most SHD can be treated.
• Yet suboptimal detection and treatment continue to persist resulting in unnecessary
health and economic costs to society.
• In an ageing society this needs to change.

6. Our report looks at the impact of SHD
in an ageing society by
• Demonstrating the health and economic case
for governments to invest in SHD.
• Outlining the barriers that contribute to suboptimal
detection and treatment in older adults.
• Presenting key recommendations to reduce
the SHD burden.

7. The health case for tackling SHD
• In an ageing world, the burden of disease due to preventable illness continues to
rise.
• In 2020, it was estimated that 14 million people in Europe lived with SHD.
• By 2040 the number of people living with SHD will increase by 43% (to 20 million).
• Quality of life is poor for those living with SHD.
• Mortality rates are increasing.

8. The economic case for tackling SHD
• Cardiovascular disease (CVD) costs the EU EUR 210 billion per
year due to healthcare costs, productivity loss, and informal care
by caregivers.
• 50% of that is healthcare spending and 26% is lost productivity.
• Earlier treatment of SHD leads to costs savings.
• Treating SHD can help support the longevity dividend.

9. Lack of awareness among the public
and primary care physicians
• Lack of awareness of SHD and its symptoms is a key barrier to people
receiving life-saving treatment.
• Individuals often dismiss symptoms as a natural consequence of
ageing.
• Little to no advertising or awareness campaigns contributes to low
awareness.
• Lack of awareness on behalf of primary care physicians means they
do not always spot the symptoms.
“Awareness is the problem. But people don’t think about it. They think the symptoms
are old age and don’t recognise deterioration could signal SHD.”
Professor Alessandro Boccanelli, Cardiologist, President of the Italian Geriatric Cardiology
Association

10. Widespread under-detection
• Late diagnosis increases the likelihood of severe disease and other comorbidities that will
make treatment more risky.
• The first step in detecting or diagnosing SHD is a stethoscope check (auscultation) of the
heart in primary care before referral to secondary care for echocardiography if an abnormality
is detected
• Despite clinical guidelines advising physicians to check their patients’ heart regularly, the
practice isn’t widespread, with just a third of older adults in Europe reporting having their heart
checked occasionally.
• Digital stethoscopes could vastly improve detection, and should be widely implemented.
“Detection can be difficult because patients modify their behaviour to mask their
symptoms, the older population in particular are not aware of symptoms and GPs are not
necessarily thinking about valve disease and recognising the red flags (for example they
may investigate COPD for breathlessness) and aren’t listening to hearts with
stethoscopes.” Wil Woan, CEO, Heart Valve Voice UK

11. Ageism in diagnosis and treatment
• Ageism is an underlying barrier to suboptimal detection and treatment.
• SHD symptoms are often dismissed as a consequence of old age.
• Younger people are more likely to receive proper cardiological
investigations.
• Medical professionals do not always use the right equipment to
assess older adults.
• There may be a reluctance among some physicians to refer patients
on for further diagnostic tests.

12. Variable standards and unequal
access to treatment
• Despite a range of treatments, a significant proportion of people with SHD are left
untreated.
• The guidelines underpinning SHD treatment have been built around younger people.
• Input from geriatricians in care and treatment decisions is also needed.
• Cardiac surgeons and cardiologists should use assessment tools such as a gait
speed test.
• Hospital capacity may affect the ability to treat patients. Suboptimal funding has
prevented some countries from using minimally invasive procedures.
“We need to ensure the patient receives the best treatment for them, not the
best treatment for the physician.”
Professor Martine Gilard, Department of Cardiology at Brest University Hospital and
former president of the French Society of Cardiology

13. Steps to ensuring high quality
treatment are in their infancy
• We need a clear pathway for treatment and patients should be treated at specialist
centres by well-trained, multidisciplinary teams.
• Clinical guidelines should be regularly updated to capture newest developments in
the management of SHD and, even more importantly. adopted in all European
countries.
• We need better training to support the growth of specialist SHD treatment
procedures.
• We also need to ensure sufficient workforce capacity.
“The biggest challenge is we find more disease but there is no additional
capacity to do more. That is the biggest challenge for people to grasp and
understand.’’
Keith Pearce, Consultant Cardiac Scientist, immediate past president for the
British Society of Echocardiography

14. Lack of systematic data collection
• Without routine data collection we are underestimating the prevalence of SHD
across Europe.
• We lack harmonised data registries that would allow us to measure inequalities in
detection and access to treatment.
• There are economic benefits to detecting, diagnosing and treating SHD earlier, but
more needs to be done to demonstrate these cost benefits to politicians.
“Innovation and technology will push on and people will develop
new products, new valves and less lengthy procedures and
quicker ways of doing things. Procedures will be easier to do in
lower co-morbidity groups which may release capacity.”
Keith Pearce, Consultant Cardiac Scientist, immediate past president
for the British Society of Echocardiography
“There is a need to Influence commissioners
and policy makers - show them that earlier
treatment is cheaper in the long run.”
Wil Woan, CEO, Heart Valve Voice UK

15. Urgent action is needed
• SHD and CVD have received little attention from policymakers.
• European policymakers acknowledge that action should be taken
to address the disease, yet there is no streamlined policy approach
and action at either the EU or country level.
• Some countries are leading the way and have dedicated specific
policy attention to SHD/CVD.
• COVID-19 has affected the diagnosis and treatment of SHD.

16. Recommendations: Increasing awareness
and improving detection and treatment
Increasing public and healthcare professional awareness
• We must improve SHD awareness among the general public.
• Primary care physicians must be better educated on SHD.
Ensuring early diagnosis with better detection
• Investing in early detection must be central to tackling
the SHD burden.
High quality treatment
• Clinical guidelines on SHD diagnosis and treatment must be
updated.
• We must create clear care pathways.

17. Recommendations: Inspiring and
engaging policymakers, healthcare
professionals and individuals
Supporting collaboration and partnership at the European level
• We must build stronger cross-country collaboration and a multi-
stakeholder approach.
Engaging politicians and policymakers with the importance of
addressing SHD
• We need strong political commitment and backing from national
politicians and policymakers.
Addressing ageism
• Addressing the impact of ageism on diagnosis, referral and treatment
must be at the centre of any policy response.

18. Recommendations: Inspiring and
engaging policymakers, healthcare
professionals and individuals
Involving all patients in care decisions
• Patients of all ages should be empowered and encouraged to come
forward for diagnosis and appropriate treatment.
Amplifying the patient voice
• Patient groups should play a key role in raising awareness, highlighting
concerns and pushing SHD up the political agenda.
Addressing workforce capacity and supporting skills training
• We must address workforce capacity; we must plan for the future and
ensure healthcare professionals get the necessary training to carry out
specialist procedures.

19. Recommendations: More effective
technology and data gathering
Better data collection
• Each European country should collect robust, standardised SHD data to
be shared across Europe for a better understanding of how SHD affects
different communities and what inequalities exist in treatment or outcome.
New technology and innovations
• Clinicians and healthcare systems must take advantage of innovations in
detection, diagnosis and treatment.
Funding of research
• The EU as a whole, as well as individual countries, must continue to invest
in SHD research.

20. Baroness Judith Jolly
UK House of Lords
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21. Professor Paolo Magni
Professor of Pathology at
Università degli Studi di Milano
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22. Silvia Perel-Levin
Chair, NGO Committee on Ageing at the UN,
Geneva
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23. Ken Bluestone
Head of Policy and Influencing at Age
International
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24. Q&A
Please submit your questions to panelists
via the Q&A tab
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25. Closing remarks
Professor Huon Gray, retired National
Clinical Director for Heart Disease at NHS
England
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26. Report launch: The longevity of sporting
legends
Register at ilcuk.org.uk/events @ilcuk
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Chair: Sir Brendan Foster CBE (Olympian)
Speakers: Alan Smith (former professional footballer), Baroness
Tanni Grey-Thompson DBE, (Paralympian), Scott Reid (Zurich
Insurance Company Ltd), Professor Chris Brady (Sportsology),
Professor Les Mayhew (ILC and The Business School).
Date: Thursday, 10 June 2021
Time: 2.00pm – 4.00pm BST

27. Challenge workshop: Work for tomorrow
Innovating for an ageing workforce
Register at ilcuk.org.uk/events @ilcuk
#WorkForTomorrow
Date: Thursday 24 June 2021
Time: 2.00pm – 4.00pm BST
(9.00am – 11.00am EDT)

28. Future of Ageing 2021: Reimagining
ageing in a changing world
Register at
http://futureofageing.org.uk/
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#FutureOfAgeing
Date: Thursday, 2 December 2021
Time: 9.00am – 5.00pm GMT
Location: Wellcome Collection, London

29. Thank you
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