Valvular heart disease (VHD) is frequent is industrialized countries and its prevalence increases with age due to the predominance of degenerative aetiology. Clinical approach is paramount for evaluation of the patient’s history, symptoms and for the detection of VHD by auscultation. Echocardiography plays a major role in diagnosis and assessment of severity and prognosis. Other investigations are mainly non-invasive and include stress testing, multimodality imaging and biomarkers. Risk stratification is essential to weigh the risk of intervention against the expected natural history of VHD. It should include risk scores, keeping in mind their limitations, in particular in the elderly. Heart valve centres are required to deliver high-quality care and provide adequate training. Non-vitamin K antagonist oral anticoagulants may be used in patients with atrial fibrillation and aortic stenosis, aortic regurgitation, mitral regurgitation, or aortic bioprostheses beyond 3 months after implantation, but are contraindicated in mitral stenosis and mechanical valves.