Related Experiment Video
Updated: Jul 19, 2025
In Silico Clinical Trials for Cardiovascular Disease
Published on: May 27, 2022
The multidisciplinary Heart Team approach for patients with cardiovascular disease: a step towards personalized
Andrea Mazza1,2, Mauro Iafrancesco1,2, Piergiorgio Bruno1,2
1Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS.
Insights
The Heart Team approach improved treatment selection agreement over time, increasing from 43% to over 70% in cardiac disease cases. This multidisciplinary discussion enhances patient care pathways and clinical outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Healthcare Management
Background:
- The Heart Team approach is generally accepted for cardiac disease management.
- Limited data exist on its impact on decision-making and clinical outcomes.
- Evaluating the evolution of agreement and adherence to recommendations is crucial.
Purpose of the Study:
- To assess the temporal changes in agreement with Heart Team discussions.
- To evaluate adherence to Heart Team recommendations.
- To determine the impact of the Heart Team on patient clinical outcomes.
Main Methods:
- Three groups of 100 cardiac patients each (G1, G2, G3) were reviewed independently by a cardiac surgeon and cardiologist.
- Cases were then discussed by the Hospital Heart Team for treatment recommendations.
- Treatment received, adherence, and in-hospital outcomes were recorded over three years (2015-2018).
Main Results:
- Treatment selection agreement increased significantly from 43% in G1 to 70% in G2 and 68% in G3.
- Agreement was lower for high-risk patients and those with aortic valve stenosis.
- Heart Team recommendations were implemented in 95% of cases, with 0.67% 30-day mortality.
Conclusions:
- Initial agreement in treatment selection via the Heart Team was low but improved significantly over time.
- Multidisciplinary case discussion is vital for optimizing patient treatment pathways.
- The Heart Team approach positively impacts decision-making and clinical results in cardiac care.
Aims:
Despite general agreement on the benefits of the Heart Team approach for patients with cardiac diseases, few data are available on its real impact on the decision-making process. The aim of the study is to define the evolution over time of the level of agreement with the systematic discussion of patients in the Heart Team and to evaluate the adherence to the Heart Team recommendations and the impact of the Heart Team on the clinical outcome of the patients.
Methods:
In 2015--2016, an experienced cardiac surgeon and a cardiologist independently reviewed clinical data of a series of 100 patients (Group 1, G1) and subsequently for each patient recommended treatment (surgical, percutaneous, hybrid or medical therapy) or further diagnostic investigations. The next day, each case was discussed by the Hospital Heart Team. The Heart Team recommendation, the subsequent treatment received by the patient and the in-hospital outcome were recorded. The same study procedure was repeated in 2017 in a second (G2) and in 2018 in a third (G3) group, both of them including 100 patients.
Results:
Complete agreement in treatment selection by the cardiac surgeon, cardiologist and the Heart Team was observed in 43% of cases in G1 and in 70% and 68% in G2 and G3, respectively (G1 vs. G2: P < 0.001, G1 vs. G3: P = 0.01, G2 vs. G3: P = 0.30). Agreement was less frequent in patients with a higher risk profile and in patients with aortic valve stenosis. The Heart Team decision was implemented in 95% of cases with a 30-day mortality of 0.67%.
Conclusion:
Agreement in treatment selection among the cardiac surgeon, cardiologist and Heart Team appears to be low in the initial experience. Subsequently, it seems to steadily increase over time up to a limit, when it reaches a plateau of stable results. Heart Team clinical cases discussion, based on both guidelines and multidisciplinary experience, represents a key step in defining the best patient treatment pathway, potentially improving the decision-making process and clinical results.
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