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The modified heart team protocol facilitated the revascularization decision-making quality in complex coronary artery

Hanping Ma1, Shen Lin1,2, Xi Li1,3

  • 1National Clinical Research Center for 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, China.

Interdisciplinary Cardiovascular and Thoracic Surgery
|February 11, 2025
PubMed

Insights

A modified heart team protocol significantly improved decision-making quality and appropriateness in complex coronary artery disease (CAD) cases compared to standard guidelines. This enhanced protocol led to higher agreement rates and fewer inappropriate decisions among specialists.

Area of Science:

  • Cardiology
  • Medical Decision Making
  • Health Services Research

Background:

  • Standardization of heart team implementation is crucial for optimal decision-making quality in complex coronary artery disease (CAD).
  • A previously established modified heart team protocol aimed to enhance decision-making quality.

Purpose of the Study:

  • To validate the effectiveness of a modified heart team implementation protocol.
  • To compare decision-making quality in complex CAD using the modified protocol versus a conventional, guideline-based approach.

Main Methods:

  • A randomized trial involving 12 heart teams in both intervention and control arms.
  • 480 complex CAD cases were independently discussed by paired heart teams, generating pairwise decisions.
  • The intervention arm used the modified protocol; the control arm used guideline recommendations. Primary outcome was inter-team pairwise decision agreement.

Main Results:

  • The intervention arm showed significantly higher overall percent agreement (72.1% vs 65.8%, P=0.04).
  • Decision-making inappropriateness was significantly lower in the intervention arm at both team-level (19.4% vs 33.0%) and specialist-level (interventional cardiologists 19.8% vs 37.7%; cardiac surgeons 19.8% vs 28.7%).

Conclusions:

  • The modified heart team implementation protocol demonstrably improved decision-making quality.
  • The protocol also enhanced the appropriateness of decisions for complex CAD patients compared to guideline-based protocols.
Abstract

Keywords:
complex coronary artery diseaseheart teamrevascularization decision-making

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