Screening for unrecognised heart valve disease

Feelings about heart valve disease screening and general health

One of the possible drawbacks of health screening tests is that they can make people feel anxious, and this is known to be one of the main reasons why people decide not to take up the offer of screening. People may get worried about the tests beforehand, even if nothing is found. If people discover they have a mild condition but no treatment is recommended, this too can cause anxiety. As part of the research, the team has been using a short questionnaire to check if the process is making people feel anxious. The results suggest around 9-10% of people have what is called ‘clinically significant’ anxiety following screening, but some specifically said it was not triggered by the screening. Over 99% said they would have screening again.

Update June 2016
Most people in the study found the scanning process acceptable, without causing undue anxiety, and the vast majority of those screened (more than 95%) said they would have echo screening again.
Everyone we talked to had decided to take part in the screening study, but George took a while to make up his mind to go. He explained that he does not like the idea of going to the doctor and being told he has something ‘incurable’.
George describes himself as someone who is not very health conscious and does not pay much attention to healthy lifestyle advice (though his wife does).
Peg and Roy also explained their feelings about screening and health.
Peg said Roy only went for screening because she made him go (see also ‘Being invited for screening). While not everyone would agree with the suggestion that good health can be down to luck, there was a certain resignation to the idea that in older age you can expect some illness. This could make people feel vulnerable – or it could lead to a feeling that there was no point worrying, because there was little you could do about it. (Certainly some people who decided not to have screening have told the research team that at their age they felt it was not worth getting checked out). Sometimes people felt a bit of both.
Like Anthony, Norman thought that it was better to know if you had a problem, though he could see others might not feel the same.
Norman took the view that ‘forewarned is forearmed’. Others agreed that knowing about a heart valve condition – even if it needed no treatment for now – could be useful information in future, especially if it started to get worse. Even if it could never be treated people could see possible benefits in knowing. For example Ursula (who did have a heart valve problem) said, “You can come to terms with it, even if there is nothing to be done.” Carolyn (who didn’t have a valve problem) agreed with this.
Several people had taken part in other forms of screening for similar reasons – for example screening for breast cancer, cervical cancer, bowel cancer and prostate cancer. Both Elizabeth and Pamela had opted to continue with breast screening past the age of 70 (the age at which the NHS currently stops issuing automatic invitations); Ursula was not aware you could choose to continue being screened, and thought she might ask her GP about it. Elizabeth explained how her attitudes had been affected by her husband’s screening for aortic aneurysm. (This is a weakness in the main artery from the heart. If it ruptures (bursts) it can be fatal).
However, there is still a lot of debate about whether screening is a good idea, for example if there is no treatment available, or if it is unclear which treatment (if any) is best.
Screening for heart valve disease is not routinely available in the UK, and the screening research project will give us new evidence about what happens to people who have a mild condition without symptoms. This in turn will help us know whether screening and early detection could prevent more serious illness, or whether the condition remains mild and screening is not necessary.
In addition to screening people talked about their more general attitudes to looking after their health. Again, it was recognised that as you get older there may be a limit to what you can do – Cathy, for example, explained that back pain problems made it harder for her to take exercise, and Anthony said, “Up until I was 60 I was playing squash about four or five times a week. Well, I don’t think I could go and play a game of squash now…But I can still walk several miles now, today. I’m lucky.”
It was quite common for people to draw a distinction between being careful and looking after yourself on the one hand, and being a hypochondriac. Norman, for example, said, “I’m not a hypochondriac, but I’m very, very tuned in to the idea that if you think your condition in some way is changing, it’s worth asking a specialist what’s happening, on the basis that on most conditions early treatment is the best approach.”
For people with mild heart valve disease, the research team advises that there is no need to alter your lifestyle and you can remain as active as you would like. Lech said he had tried to cut down on fatty foods, which is always sensible, but generally the advice is to carry on just as before.

Last reviewed August 2016.
Last updated August 2016.


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