Disease stages in patients with valvular heart dis- ease should be classified (Stages A, B, C, and D) on the basis of symptoms, valve anatomy, the severity of valve dysfunction, and the response of the ventricle and pulmonary circulation. 2. In the evaluation of a patient with valvular heart disease, history and physical examination find- ings should be correlated with the results of noninvasive testing (ie, ECG, chest x-ray, trans- thoracic echocardiogram). If there is discordance between the physical examination and initial noninvasive testing, consider further noninva- sive (computed tomography, cardiac magnetic resonance imaging, stress testing) or invasive (transesophageal echocardiography, cardiac catheterization) testing to determine optimal treatment strategy. 3. For patients with valvular heart disease and atrial fibrillation (except for patients with rheumatic mitral stenosis or a mechanical prosthesis), the decision to use oral anticoagulation to prevent thromboembolic events, with either a vitamin K antagonist or a non vitamin K antagonist anti- coagulant, should be made in a shared decision- making process based on the CHA2 -VASc score. Patients with rheumatic mitral stenosis or a mechanical prosthesis and atrial fibrillation should receive oral anticoagulation with a vitamin K antagonist. 4. All patients with severe valvular heart disease being considered for valve intervention should be evaluated by a multidisciplinary team, with either referral to or consultation with a Primary or Comprehensive Valve Center. 5. Treatment of severe aortic stenosis with either a transcatheter or surgical valve prosthesis should be based primarily on symptoms or reduced ven- tricular systolic function. Earlier intervention may be considered if indicated by results of exercise testing, biomarkers, rapid progression, or the presence of very severe stenosis. 6. Indications for transcatheter aortic valve implan- tation are expanding as a result of multiple randomized trials of transcatheter aortic valve implantation versus surgical aortic valve replace- ment. 