ACC/AHA Management of Patients With Valvular Heart Disease Guideline Summary

Design and created by Guideline Central in participation with the American College of Cardiology and American Heart Association.

Document Overview

Document Title: Management of Patients With Valvular Heart Disease

Authoring Societies

American College of Cardiology

American Heart Association

Endorsing Societies

American Association for Thoracic Surgery

American Society of Echocardiography

Society for Cardiovascular Angiography and Interventions

Society of Cardiovascular Anesthesiologists

Society of Thoracic Surgeons

Document Publication Date: Dec 17, 2020

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.ahajournals.org/doi/10.1161/CIR.0000000000000923

Source Citation: Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e72-e227. doi: 10.1161/CIR.0000000000000923. Epub 2020 Dec 17. Erratum in: Circulation. 2021 Feb 2;143(5):e229. PMID: 33332150.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: The focus of this guideline is the diagnosis and management of adult patients with valvular heart disease (VHD). A full revision of the original 1998 VHD guideline was made in 2006, and an update was made in 2008. Another full revision was made in 2014, with an update in 2017. There was an additional statement of clarification specifically for surgery for aortic dilation in patients with bicuspid aortic valves (BAV) in 2016. The present guideline will replace the 2014 guideline and 2017 focused update. Some recommendations from the earlier VHD guidelines have been updated as warranted by new evidence or a better understanding of earlier evidence, whereas others that were inaccurate, irrelevant, or overlapping were deleted or modified. Throughout, our goal was to provide the clinician with concise, evidence-based, contemporary recommendations and the supporting documentation to encourage their use. Where applicable, sections were divided into subsections of 1) diagnosis and follow-up, 2) medical therapy, and 3) intervention. The purpose of these subsections is to categorize the Class of Recommendation according to the clinical decision-making pathways that caregivers use in the management of patients with VHD.

Scope: Assessment and Screening, Management

Keywords: TAVR, VHD, aortic stenosis, heart valves, mitral regurgitation, transcatheter aortic valve replacement (TAVR), tricuspid stenosis, valvular heart disease

Target Patient Population: patients with valvular heart disease

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital, Operating and Recovery Room, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 286

Literature Search Start Date: Monday, January 1, 1990

Literature Search End Date: Saturday, December 31, 2016

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes