Leveraging Self-Reporting in an Existing e-Cohort to Identify Clinically Relevant Mitral Valve Prolapse: Pilot Questionnaire Study

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Background: Mitral valve prolapse (MVP) is a common valvulopathy associated, in a minority of cases, with heart failure, severe mitral regurgitation (MR), and sudden arrhythmic death. Digital tools hold promise for faster and more efficient recruitment of study participants into a large-scale MVP Registry. Objective: This study sought to evaluate the feasibility of surveying participants in an existing e-cohort to identify and clinically characterize MVP cases based on self-reporting and to recruit them in an MVP Registry at the University of California, San Francisco. Methods: We surveyed Northern Californian participants of the Health eHeart Study, a large e-cohort using the Eureka digital research infrastructure, about a prior diagnosis of MVP. MVP-positive respondents were asked to provide relevant medical records to confirm their eligibility and were invited to enroll in an MVP Registry if evidence of MVP was confirmed. A follow-up survey was sent after 1 month and after 5 years to collect data about clinical outcomes, including arrhythmias and the need for mitral valve repair. Results: The survey was delivered to 5746 participants, and 520 completed responses were collected. A prior diagnosis of MVP was self-reported by 16.3% (85/520) of respondents. Echocardiograms were obtained from 51.8% (44/85) of participants, and evidence of MVP was confirmed in 32.9% (n=28) of individuals, all of whom joined the registry. Participants with more severe MR had a higher number of correct responses regarding both MVP (odds ratio [OR] 10.58, 95% CI 3.58-63.04; P<.001) and MR diagnosis (OR 4.86, 95% CI 2.11-16.14; P=.002). Longitudinal data were available from most patients through responses to a follow-up survey sent 1 month and 5 years later (18/28, 64.3% and 17/28, 60.7% of MVP confirmed respondents, respectively). Among the patients with electronic health records available, 75% (3/4) had a correct self-reported diagnosis of arrhythmia. Conclusions: e-Cohort methods with self-reported clinical data can be used to prescreen candidates for a research study of MVP. These methods can rapidly identify and retain, among many cases of benign MVP, the minority with clinically relevant presentations such as significant MR and ventricular arrhythmias. These cases may be missed, especially when asymptomatic, by small-scale clinic-based recruitment or family screening methods.

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