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Institution of a formal multidisciplinary heart team for high-risk coronary revascularization
Srinivasa Potluri1, Rahul Sawhney1, Cody Dorton2
1Department of Cardiology, Baylor Scott & White The Heart Hospital - Plano, Plano, Texas, USA.
Insights
A new multidisciplinary heart team was established to manage high-risk complex coronary artery disease patients. This approach aims to improve decision-making and patient outcomes in complex cardiac care.
Area of Science:
- Cardiology
- Interventional Cardiology
- Healthcare Management
Background:
- The heart team approach is standard for complex coronary artery disease but lacks a consistent definition.
- Evaluating high-risk patients for coronary revascularization requires a specialized, multidisciplinary team.
Purpose of the Study:
- To establish an extended, multidisciplinary heart team for high-risk coronary revascularization.
- To define a new service, workflow, and paradigm for evaluating complex coronary artery disease patients.
Main Methods:
- Described the creation of a high-risk percutaneous coronary intervention (PCI) team.
- Outlined risk criteria, patient evaluation processes, and quality assurance measures.
- Initiated a prospective study of 200 complex coronary artery disease patients.
Main Results:
- The study is designed to assess the impact of the multidisciplinary heart team on revascularization decisions.
- Primary outcomes include mortality, major adverse cardiac events, and procedural complications.
- Secondary outcomes focus on acute kidney injury, bleeding, and length of stay.
Conclusions:
- Establishing a multidisciplinary heart team can aid in managing complex patient scenarios.
- This approach has the potential to improve patient outcomes in high-risk coronary artery disease.
- A formal study is underway to validate these potential benefits.
Introduction:
The heart team approach is now the standard of care for patients with complex coronary artery disease; however, the definition of a heart team is variable. We embarked on a project to create an extended, multidisciplinary heart team to evaluate patients we deemed high risk for coronary revascularization. In doing so, we created a new service, workflow, and paradigm.
Methods:
Herein, we describe the process through which we created our high-risk percutaneous coronary intervention team, our criteria for determining risk, our process for evaluating these patients, and quality assurance. Additionally, we describe the design of our prospective study assessing 200 patients with complex coronary artery disease. The primary outcomes include the final heart team revascularization decision, all-cause mortality, major adverse cardiac events, acute kidney injury, postintervention bleeding, and length of stay.
Conclusion:
Establishing a multidisciplinary heart team may help with complex and high-risk patient and family scenarios and potentially improve patient outcomes. A study has been initiated to test this hypothesis formally.
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