Leading Off: Guidelines make managing canine heart disease more clear-cut
In December 2009, an international panel of veterinary cardiologists published a new American College of Veterinary Internal Medicine (ACVIM) consensus statement outlining the current diagnosis and treatment of chronic valvular heart disease in dogs (see the Related Link "ACVIM canine chronic valvular heart disease consensus statement" below to read the complete guidelines). In incorporating a new scheme for categorizing heart disease and failure into the guidelines, the document provides a framework for veterinarians to think about diagnostic strategies to screen for the presence of valvular disease, and it reviews and evaluates the current scientific evidence for the diagnostic and therapeutic strategies recommended at every stage of the disease.
These guidelines provide insight into some of the ongoing controversies in veterinary cardiology, including areas in which the panel could not agree on the best clinical practice (e.g. how to manage clinically asymptomatic dogs with structurally significant mitral valve insufficiency). The guidelines also spell out areas of unanimous current consensus that provide a practical guide for your day-to-day practice (e.g. standard therapy for dogs with clinical signs of heart failure caused by mitral valve insufficiency should ideally include a combination of furosemide, pimobendan, and an angiotensin-converting enzyme inhibitor).
Like any new practice guidelines, ACVIM consensus statements come with the hope that they will provide useful information that will inform and perhaps change the way practicing veterinarians think about heart failure, convincing and encouraging us to adopt what the panel considers to be current best practices. Dr. Warren Warwick (First Annalisa Marzotto Professor for Cystic Fibrosis Patient Care at the University of Minnesota) would remind us, however, that "practice guidelines should come with an expiration date."In this case, the shelf life of the ACVIM consensus guidelines for diagnosing and treating chronic valvular heart disease is likely to be relatively short. So keep your eye on this space for breaking news regarding the results of pivotal clinical trials under way that address some of the areas of controversy and uncertainty outlined in the current document, particularly the management of dogs with asymptomatic mitral valve insufficiency, and new treatments that either address the structure of the valve itself or add to our arsenal for treating refractory heart failure.
In the meantime, I hope you will profit from the panel's hard work and effort in making the diagnosis and care of dogs with heart disease more accessible and understandable.
Dr. Bruce Keene, a professor of cardiology at North Carolina State University's College of Veterinary Medicine, was chair of the ACVIM Specialty of Cardiology consensus panel that prepared the recently released "Guidelines for the Diagnosis and Treatment of Canine Chronic Valvular Heart Disease."