Related Experiment Video
Updated: Mar 27, 2026
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Implementation and consistency of Heart Team decision-making in complex coronary revascularisation
Antonis N Pavlidis1, Divaka Perera2, Grigoris V Karamasis3
1Department of Cardiology, St. Thomas' Hospital, London, UK.
Insights
The Heart Team approach for complex coronary artery disease (CAD) is a robust and reproducible process. Decisions made by the Heart Team are implemented in most cases, ensuring effective patient management.
Area of Science:
- Cardiology
- Clinical Decision-Making
- Health Services Research
Background:
- Multidisciplinary team (MDT) approach is recommended for complex coronary artery disease (CAD).
- Guidelines support Heart Team (HT) decision-making in myocardial revascularisation.
Purpose of the Study:
- Evaluate the implementation and consistency of Heart Team (HT) decision-making.
- Assess the reproducibility of HT decisions in complex coronary revascularisation.
Main Methods:
- Prospective evaluation of 399 patients from 51 MDT meetings.
- Random subset re-presented to a blinded panel to assess decision reproducibility.
- Analysis of decision implementation rates.
Main Results:
- Most common decisions: medical management (30%), coronary artery bypass grafting (CABG) (26%), percutaneous coronary intervention (PCI) (17%).
- Decisions were implemented in 93% of cases.
- 80% of initial HT recommendations were reproduced upon re-discussion.
Conclusions:
- The Heart Team (HT) process is robust for managing complex CAD.
- HT decisions demonstrate significant reproducibility.
- Successful implementation of decisions highlights the process's effectiveness, emphasizing the need for complete clinical information and patient preference.
Background:
A multidisciplinary team (MDT) approach for decision-making in patients with complex coronary artery disease (CAD) is now a class IC recommendation in the European and American guidelines for myocardial revascularisation. The aim of this study was to evaluate the implementation and consistency of Heart Team HT decision-making in complex coronary revascularisation.
Methods:
We prospectively evaluated the data of 399 patients derived from 51 consecutive MDT meetings held in a tertiary cardiac centre. A subset of cases was randomly selected and re-presented with the same clinical data to a panel blinded to the initial outcome, at least 6 months after the initial discussion, in order to evaluate the reproducibility of decision-making.
Results:
The most common decisions included continued medical management (30%), coronary artery bypass grafting (CABG) (26%) and percutaneous coronary intervention (PCI) (17%). Other decisions, such as further assessment of symptoms or evaluation with further invasive or non-invasive tests were made in 25% of the cases. Decisions were implemented in 93% of the cases. On re-discussion of the same data (n=40) within a median period of 9 months 80% of the initial HT recommendations were successfully reproduced.
Conclusions:
The Heart Team is a robust process in the management of patient with complex CAD and decisions are largely reproducible. Although outcomes are successfully implemented in the majority of the cases, it is important that all clinical information is available during discussion and patient preference is taken into account.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:29Cardiomyopathy V: Interprofessional Care
01:26Cardiac Catheterization IV: Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview