Should older adults be screened for heart valve disease before symptoms appear?

Valvular heart disease (VHD) affects up to half of adults over 65 — and most don't know they have it. The condition is often clinically silent until it reaches an advanced, harder-to-treat stage. Yet neither the 2020 AHA/ACC nor the 2025 ESC/EACTS guidelines recommend routine screening for asymptomatic adults, leaving physicians without a clear playbook.

Detection today is largely "opportunistic" — catching a murmur during a routine exam — but that approach misses a lot. Standard auscultation detects only 32% of mild and 44% of significant VHD in primary care patients. Echocardiography is far more accurate, and one prospective study found 16% of adults 65+ had previously undiagnosed moderate or severe valve disease, with 77% of those patients reporting minimal or no symptoms.

By the Numbers:

• Up to 50% of adults over 65 have VHD, often without symptoms
• Auscultation detects only 32% of mild and 44% of significant VHD
• 16% of screened adults 65+ had undiagnosed moderate/severe VHD (Heart of New Ulm Valve Study)
• VHD prevalence rises from 42.4% at ages 65–69 to 76.3% at ages 85–95 (OxVALVE)
• Echocardiogram screening for aortic stenosis at age 80 estimated at CA$28,005 per QALY — within cost-effective thresholds

Why it matters: As the US population over 65 grows rapidly, the gap between VHD prevalence and detection is becoming a pressing clinical and policy challenge. Early intervention consistently outperforms late-stage treatment, making the case for structured screening programs — if the field can agree on how to do it safely and affordably.