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Impact of Hierarchy on Multidisciplinary Heart-Team Recommendations in Patients with Isolated Multivessel Coronary

Mohamed Abdulrahman1, Alaa Alsabbagh2, Thomas Kuntze3

  • 1Division of Cardiology, Zentralklinik, Bad Berka 99437, Germany. kal@zentralklinik.de.

Journal of Clinical Medicine
|September 25, 2019
PubMed

Insights

Physician hierarchy significantly influences Heart Team (HT) decisions for multivessel coronary disease (MVD) treatment, impacting recommendations between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). This hierarchy effect persisted over time.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Health Services Research

Background:

  • Heart Team (HT) discussions are guideline-recommended for optimizing myocardial revascularization in multivessel coronary disease (MVD).
  • The impact of physician hierarchy on HT treatment recommendations remains unexamined in existing literature.
  • This study investigates how the presence of surgical and cardiology leadership affects HT decisions for MVD.

Purpose of the Study:

  • To analyze the influence of the presence of the Head of Cardiovascular Surgery (HOS) and Head of Cardiology (HOC) on Heart Team (HT) recommendations.
  • To compare treatment choices (coronary artery bypass grafting vs. percutaneous coronary intervention) based on leadership attendance in HT meetings.
  • To assess if hierarchical influence on MVD treatment decisions changes over time.

Main Methods:

  • Retrospective analysis of 209 Heart Team (HT) discussions for isolated multivessel coronary disease (MVD) between 2012 and 2015.
  • Categorization of HT meetings based on the attendance of the Head of Cardiovascular Surgery (HOS) and Head of Cardiology (HOC): both present, neither present, or only one present.
  • Comparison of recommended treatments (coronary artery bypass grafting [CABG] vs. percutaneous coronary intervention [PCI]) across these attendance categories.

Main Results:

  • When neither HOS nor HOC was present, recommendations were 69% CABG and 31% PCI.
  • With both HOS and HOC present, recommendations were 77% CABG and 23% PCI (p=0.34).
  • Significant differences emerged when only one leader was present: 83% CABG/17% PCI (HOS only) vs. 54% CABG/46% PCI (HOC only) (p<0.0001).

Conclusions:

  • Physician hierarchy within the Heart Team (HT) significantly impacts treatment recommendations for multivessel coronary disease (MVD).
  • The presence of cardiology leadership (HOC) strongly influences the shift towards percutaneous coronary intervention (PCI) compared to surgery.
  • This hierarchical influence on HT decisions for MVD did not diminish over the study period.

Keywords:
coronaryheart teamhierarchyinterventionmultivessel disease

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