Premortem clinical information is specific but not very sensitive for the postmortem diagnosis of heart valve disease

The OxVALVE study group, led by Dr Bernard Prendergast (Oxford Valvular Heart Disease Population Study) group was established in 2009 to determine whether the early detection and treatment of valvular heart disease may improve the long term care pathways and health of patients. The primary study was conducted using a community-based, prospective cohort that recruited individuals over the age of 65 years.

In February 2017, as part of the OxVALVE study group, we published, in Heart, the largest reported study (n=7,879) to evaluate the correlation between valvular heart disease findings pre- and post-mortem. Whilst there are some inherent limitations to our approach, we were able to demonstrate that clinical information available prior to death, whilst highly specific, was a relatively insensitive predictor for the cause of death that was established at autopsy*. High positive and negative predictive values were noted. Overall, we were able to demonstrate that undiagnosed valvular heart disease contributed towards death in ~1.7% of our population, most commonly due to: aortic stenosis, infective endocarditis and rheumatic heart disease.

*Sensitivity is used to understand how often a test will correctly identify a positive finding from all the positive findings. If a test is highly sensitive, and the test result is negative, you can be nearly certain they don’t have the disease. Sensitivity can be calculated by dividing the total number of true positives by the sum of true positives and false negatives.

Specificity also known as the true negative rate, as it assesses how often people without a disease are correctly given a negative result. Therefore, if the test result for a highly specific test is positive you can be nearly certain that they actually have the disease. Specificity is calculated by dividing the total number of true negatives by the sum of the true negatives and false positives.

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