Severe mitral regurgitation (MR), whether isolated or with coronary disease, was associated
with adverse clinical outcomes. However, clinician practice is characterized by different
thresholds for treatment. No data exist that described current practice patterns,
factors that affected these patterns, or whether physicians followed American College
of Cardiology/American Heart Association guidelines in clinical practice for patients
with MR. Cardiovascular specialists were surveyed using e-mail, and 1,076 physicians
completed the survey (71% response rate), including adult cardiologists (94%) and
cardiac surgeons (5%) who practiced in the United States (78%), Canada (5%), and other
nations (17%). Wide variations were noted regarding rates of referral of asymptomatic
patients with severe MR for mitral valve repair. There was geographic and specialty-dependent
heterogeneity in practice. Most physicians (65%) used medications to delay the progression
of MR in the absence of guideline recommendations. A minority (28%) of respondents
routinely quantitated MR by calculating the effective regurgitant orifice area. In
patients undergoing percutaneous coronary intervention, MR severity was not assessed
before the procedure by 1 in 4 providers, and the presence of MR frequently did not
affect clinical care decisions. In conclusion, considerable variability existed in
the clinical management of MR, particularly regarding referral of asymptomatic patients
for mitral valve reparative surgery. Medications were frequently used to treat asymptomatic
patients with MR in the absence of evidence of pharmacologic efficacy. MR was frequently
not considered a relevant factor before treatment of patients with coexistent coronary
artery disease.