Heart Team Approach: The New Standard for CV Care?

The heart team concept is at the heart of modern cardiovascular care, according to a new state-of-the-art paper published on Feb. 25 in the Journal of the American College of Cardiology.

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Managing care for patients with complex cardiovascular disease has changed substantially over the last decade with the advent of appropriate use criteria, advances in information technology, and an increasing amount of evidence-based data. As a result, synthesizing the large quantity of information so that care management options are understandable to patients and their families is of critical importance. Enter "Heart Teams."

"The central goal of patient-centric care requires that the patient and family be sufficiently educated about the alternatives available so that their expectations can be met as fully as possible," the authors note. "To facilitate this process of patient centric evidence-based care, multidisciplinary Heart Teams have become identified as cornerstones."

In fact, the Heart Team is so important that the 2010 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery Guidelines for Coronary Revascularization and the 2012 ACC Appropriate Use Criteria for Coronary Artery Bypass Grafting (CABG) surgery both list the Heart Team as a class 1 indication for treatment.

The paper highlights the balanced and complementary approach to patient care offered by the Heart Team as a result of joint and shared decision making among multi-disciplinary stakeholders. In the case of coronary revascularization, for example, Heart Teams will need to consist of cardiovascular surgeons, interventional cardiologists and primary cardiologists. More recently, in the case of transcatheter aortic valve replacement, Heart Teams will need to consist surgeons, interventionalists, and general cardiologists, as well as imaging specialists, neurologists, cardiac anesthesiologists and others vital to patient selection and optimal procedural performance.

"Decision making has evolved over time. Many years ago, when options were limited to either medical or surgical, clinical decisions were relatively simpler and the Heart Team was smaller and more cohesive," said ACC President William Zoghbi, MD, FACC, who was one of the authors of the paper. "With the introduction of catheter-based approaches in addition to surgery, we became more siloed. As choices and treatments are now more complex, we need to rekindle the Heart Team approach: a collective input and wisdom from a complement of medical, surgical and interventional experts is needed for optimal decision making. This team approach, inclusive of shared-decision making with patients, is at the crux of patient-centered care."

The paper does point out that specific strategies for implementation of Heart Teams will vary as a result of things like institutional structure or facility limitations, but the authors point out that the broad concept must evolve to become the standard of cardiovascular care moving forward. "Failure to implement a Heart Team is increasingly not an option," the authors conclude. "By exploring the multiple options available and sharing them with patients and their families where applicable, more optimal shared decision making is achieved, along with a tailored recommendation for therapy for a more informed and engaged patient. From a professional team point of view, subsequent joint participation in procedures can not only improve the skill sets of all involved medical and surgical personnel but also elevate the cognitive interchange that occurs among the specialties."

Keywords: Physicians, Patient Care, Thoracic Surgery, Patient-Centered Care, Complement System Proteins, Patient Selection, Myocardial Revascularization, Medicine, Cardiovascular Diseases, Coronary Artery Bypass, United States

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