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Optimal Heart Team Protocol to Improve Revascularization Decisions in Patients with Complex Coronary Artery Disease:

Hanping Ma1, Shen Lin1,2, Xi Li1

  • 1National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

European Heart Journal. Quality of Care & Clinical Outcomes
|October 11, 2021
PubMed

Insights

Heart team agreement for complex coronary artery disease revascularization decisions was moderate. Factors influencing discrepancies were identified, leading to a proposed heart team protocol to improve decision-making stability.

Area of Science:

  • Cardiology
  • Health Services Research

Background:

  • Current guidelines advocate for heart teams in complex coronary artery disease (CAD) decision-making.
  • The stability and optimal protocol for these heart teams remain unevaluated.

Purpose of the Study:

  • To assess inter-team agreement in revascularization decisions for complex CAD patients.
  • To identify factors influencing decision-making discrepancies within heart teams.
  • To inform the development of a standardized heart team protocol.

Main Methods:

  • A sequential, explanatory mixed-methods study.
  • Quantitative phase: Assessed inter-team agreement using kappa statistic for 101 complex CAD patients across 4 heart teams (16 specialists).
  • Qualitative phase: Semi-structured interviews with heart team members to explore decision-making influences.

Main Results:

  • Moderate inter-team agreement for revascularization decisions (kappa = 0.58).
  • Key influencing factors identified: specialist quality, team composition, and meeting process.
  • Generated recommendations for heart team implementation across five levels.

Conclusions:

  • Heart team agreement in complex CAD revascularization is moderate, highlighting variability.
  • A novel, detailed heart team protocol was developed based on identified influencing factors.
  • Further validation of the proposed protocol is recommended for clinical deployment.
Abstract

Keywords:
Complex coronary artery diseaseDecision-making agreementHeart teamMixed methods study

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