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Prognostic Impact of Implementation of Heart Team Approach on Cardiovascular Outcomes in Patients With Complex
Po-Hsueh Su1,2, Ya-Lin Huang1, Po-Wei Chen1
1Department of Internal Medicine, Division of Cardiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
A quality improvement program boosted heart team approach (HTA) use for complex coronary artery disease (CAD) patients. This led to better treatment choices and improved cardiovascular outcomes, reducing major adverse events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Stable coronary artery disease (CAD) treatment involves medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG).
- Treatment decisions for CAD depend on disease severity and revascularization risk, with guidelines recommending a heart team approach (HTA).
- Despite recommendations, PCI is frequently chosen over CABG in complex CAD cases.
Purpose of the Study:
- To evaluate the impact of a quality improvement program on HTA activation and revascularization strategies in complex CAD patients.
- To compare cardiovascular outcomes between patients managed with and without HTA.
Main Methods:
- Retrospective analysis of 753 complex CAD patients (SYNTAX score ≥33) from January 2019 to April 2022.
- Implementation of a quality improvement program including a clinical decision flow map, risk score support, and HTA standard operating procedure.
- Comparison of HTA activation rates, revascularization choices, and long-term composite endpoints (death, myocardial infarction, unplanned revascularization) between HTA and non-HTA groups.
Main Results:
- The quality improvement program significantly increased HTA activation from 26.4% to 61.7%.
- CABG selection increased from 11.1% to 20.4% following program implementation.
- The HTA group demonstrated higher rates of appropriate CABG recommendations (75.5% vs. 37.2%) and choices (26.8% vs. 7.2%), and experienced a lower incidence of the composite endpoint (18.1% vs. 42.4%).
Conclusions:
- A structured quality improvement program effectively enhances heart team approach activation and optimizes revascularization strategies for complex CAD.
- Implementing this program leads to improved cardiovascular outcomes in patients with complex coronary artery disease.
Background:
In patients with stable coronary artery disease (CAD), treatment options include medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). The decision between PCI and CABG depends on disease severity and revascularization risk. Guidelines promote a heart team approach (HTA) with shared decision-making, yet PCI remains prevalent.
Methods And Results:
We conducted a retrospective analysis of 753 patients with complex CAD (left main or multivessel disease and SYNTAX score ≥ 33) between January 2019 and April 2022. We evaluated a quality improvement program featuring a clinical decision flow map, a support system for risk score calculations, and a standard operating procedure for HTA. We compared HTA activation, revascularization strategy choices, and long-term cardiovascular outcomes (composite endpoint: death, myocardial infarction, or unplanned revascularization) between patients treated with HTA (HTA group, n = 448) and without HTA (non-HTA group, n = 304). The program significantly increased HTA activation (from 26.4% to 61.7%) and CABG selection (from 11.1% to 20.4%). The HTA group had better CABG recommendations and choices (75.5% vs. 37.2%, and 26.8% vs. 7.2%, respectively), with a lower incidence of the primary composite endpoint (18.1% vs. 42.4%).
Conclusion:
A quality improvement program enhances HTA activation and revascularization strategies, leading to improved cardiovascular outcomes in complex CAD patients.
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