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 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 ignored the first letter from his surgery because he was worried about where it might lead…

Age at interview 86

Gender Male

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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.

Roy sees himself as quite lucky health-wise and does not worry about it much. Peg has had more…

Age at interview 71

Gender Male

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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.

Hugh never used to worry about his health but now feels he has reached a vulnerable stage in…

Age at interview 68

Gender Male

Age at diagnosis 68

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Generally Brian feels fit. He is concerned about his heart valve problem and whether it can be…

Age at interview 71

Gender Male

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Chris eats sensibly and keeps active, but he doesn’t bother with flu jabs and is not one to rush…

Age at interview 70

Gender Male

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Anthony thinks at his age health problems are unavoidable. He would rather know if something is…

Age at interview 78

Gender Male

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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 would rather know about any health problem and have it monitored, but some people might…

Age at interview 77

Gender Male

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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.

Carolyn would encourage people to have heart valve screening. Its reassuring if nothing is wrong…

Age at interview 69

Gender Female

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If he had private health insurance Chris would have an annual health check. It’s good to find out…

Age at interview 70

Gender Male

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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).

Elizabeth’s husband took part in research into screening for aortic aneurysm and she believes it…

Age at interview 76

Gender Female

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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.

Fraser has had prostate cancer screening, but he knows that the results can be hard to interpret…

Age at interview 68

Gender Male

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Normans GP thinks screening for prostate cancer is a bad idea, but Norman thinks its a useful…

Age at interview 77

Gender Male

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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 nowBut 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.’

Susie says she is not a hypochondriac, but she tries to keep active, she doesnt smoke, and she…

Age at interview 74

Gender Female

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Cathy and Fraser say they dont worry about their health, but they are conscious of it and try to…

Age at interview 68

Gender Male

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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.

Ursula is not affected by the condition and it has not changed her lifestyle at all.

Age at interview 82

Gender Female

Age at diagnosis 81

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Looking back Brian is glad he had screening. He recommends it to other people, and says his…

Age at interview 71

Gender Male

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Attending follow up appointments

The scan at the first appointment is looking for previously unrecognised heart valve disease. Anyone who is suspected to have a heart valve problem following...