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The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease

Stuart J Head1, Sanjay Kaul, Michael J Mack

  • 1Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.

European Heart Journal
|February 22, 2013
PubMed

Insights

Implementing a multidisciplinary Heart Team improves treatment decisions for stable complex coronary artery disease. This collaborative approach ensures optimal revascularization strategies by integrating diverse expertise and patient preferences.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Stable complex coronary artery disease (CAD) treatment options include coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical therapy.
  • Optimal treatment selection for stable complex CAD requires multidisciplinary decision-making, yet the 'Heart Team' concept is underutilized.
  • Suboptimal decision-making leads to significant variability in PCI-to-CABG ratios, raising concerns about overuse, underuse, and inappropriate revascularization.

Purpose of the Study:

  • To review evidence supporting the benefits of a multidisciplinary Heart Team for stable complex CAD.
  • To emphasize the importance of integrating clinical, interventional, and surgical expertise in treatment planning.
  • To discuss organizational aspects, patient involvement, and validation of the Heart Team approach.

Main Methods:

  • Review of existing data and literature on Heart Team decision-making in stable complex coronary artery disease.
  • Analysis of factors influencing treatment selection, including diagnostic evidence, patient condition, preferences, and local expertise.
  • Discussion of the collaborative process involving cardiologists and cardiac surgeons.

Main Results:

  • A multidisciplinary Heart Team, comprising clinical/non-invasive cardiologists, interventional cardiologists, and cardiac surgeons, enhances treatment strategy recommendations.
  • The Heart Team approach facilitates better analysis of diagnostic evidence and contextualization of patient's clinical status.
  • Shared decision-making with patients, considering individual preferences and local expertise, leads to more optimal joint treatment strategies.

Conclusions:

  • The multidisciplinary Heart Team is crucial for optimizing treatment selection in stable complex coronary artery disease.
  • Effective Heart Team implementation requires addressing organization, logistics, and stakeholder involvement (physicians, patients, personnel).
  • Further validation is needed, but the Heart Team model offers a superior framework for complex CAD management.

Keywords:
AppropriatenessCoronary artery bypass graftingGuidelinesHeart TeamMultidisciplinaryPercutaneous coronary interventionRevascularizationShared decision-makingUnderuse

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