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Read Original Story

The mitral valve question

Rating

3 Star

The mitral valve question

Our Review Summary

This story highlighted a difference between the way mitral valve problems are commonly treated and the treatment recommended in the guidelines (American College of Cardiology/American Heart Association – though this guideline source was not actually mentioned in the article).  It provided some insight for individuals who might be making a decision about treatment for this specific problem, but also for helping people in general think about questions they might want to get answers to for whatever ailment they are seeking relief for.  Discussed within the story was the trade-off between convenience of treatment and the wisdom of seeking treatment in a high-volume center for people to weigh whenever they are contemplating invasive therapy.

The story failed to provide complete information about the treatment options so that a person could compare the absolute benefits and risks associated with each. The focus of the story was to highlight the discrepancy between the recommended course of action and the current common one – which it did well.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There was no estimate for the cost for either mitral valve repair or replacement, though the story did raise the insurance coverage issue.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story should have compared and quantified the benefits of mitral valve repair with mitral valve replacement.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story mentioned that with mitral valve replacement there were medications that would need to be taken for the rest of the patient’s life, and that there was an expectation that the valve would need replacement again in 10 to 12 years.  

The story did not include any similar perspective for valve repair.  For valve repair, the story mentioned improved heart function, less risk of blood clots, stroke and infection though it did not provide estimates for the magnitude of those benefits.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

While mentioning guideline recommendations for mitral valve surgical interventions, it would have been useful for readers to provide some detail about those guidelines.  When discussing the guidelines "issued here in 2006", it would appear that the story was referring to those issued by the American College of Cardiology/American Heart Association.  It is helpful for readers to know the source of the recommendations so they can have a context for the value of that recommendation.

Further while the story mentioned that ’tissue valves from pigs or even cadavers – give out in 10 to 12 years’, the ACC/AHA guidelines mention that the reoperation rate is the same for mitral valve replacement and repair – about 7-10%.    The story would have had better balance if it had included this.
It would have been helpful for readers to have some complication rates, mortality rates, and how the two surgical treatments compare in terms of companion medications.  In addition, it would have been helpful to include information about the benefits that can be obtained from mitral valve surgery.

Does the story commit disease-mongering?

Satisfactory

Though the story did not engage in disease mongering, it presented the sobering notion that thousands of individuals who undergo surgery for a leaky mitral valve are not receving the treatment. 

Does the story use independent sources and identify conflicts of interest?

Satisfactory

One expert, who does not appear to be directly associated with the guidelines referred to in the article itself, was quoted in this piece. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story was about two surgical treatments for dealing with mitral valve problems – repair and replacement.  It offered information about the underutilization of mitral valve repair.  It did not contain information about the natural history of mitral valve ‘problems’, and included nothing about the option of having neither treatment.  

However, the focus of the story was to highlight the difference between guideline recommendations and the current pattern of treatment.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story mentioned that only half of patients having surgery for leaky mitral valves have them repaired, which was deemed ‘unacceptable’ by the expert quoted.  The story explained that this treatment was not readily available and that for many, it would require ‘distant referral’.

Does the story establish the true novelty of the approach?

Satisfactory

The story highlighted underutilization of mitral valve repair as opposed to mitral valve replacement..

Does the story appear to rely solely or largely on a news release?

Satisfactory

Des not appear to rely on a press release

Total Score: 6 of 10 Satisfactory

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