Real-Time Heart Team for Revascularization in Complex Coronary Artery Disease: The EHEART Randomized Trial

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Implementing traditional heart teams for complex coronary artery disease (CAD) is hindered by limited specialist availability for face-to-face meetings.
• A real-time, online heart team during angiography offers a solution for efficient resource integration.

Purpose of the Study:

• To evaluate the implementation value and safety of a real-time heart team decision-making approach for complex CAD patients.
• To compare care efficiency, process metrics, and clinical outcomes between real-time and conventional heart teams.

Main Methods:

• A noninferiority randomized controlled trial involving 490 patients with complex CAD across 3 centers.
• Patients were assigned to either a conventional face-to-face heart team or a real-time online heart team during angiography.
• Outcomes included care efficiency (waiting times, costs), process evaluation (discussion adequacy, participation), and 1-year major adverse cardiovascular and cerebrovascular events (MACCE).

Main Results:

• The real-time heart team group showed significantly reduced waiting times for therapy, lower recatheterization rates, decreased specialist workload, and lower PCI hospitalization costs.
• While discussion time and specialist satisfaction improved, shared decision-making was less frequent in the real-time group.
• The real-time approach was noninferior to the conventional method regarding 1-year MACCE (8.2% vs 10.6%).

Conclusions:

• The real-time heart team approach enhances care efficiency and process metrics for complex CAD patients compared to conventional methods, with similar clinical outcomes.
• Optimization of shared decision-making and intercenter generalizability is needed before widespread adoption.
• The study demonstrates the feasibility and effectiveness of real-time heart teams in managing complex CAD.