Decision making has evolved over time. Many years ago, when options were limited to either medical or surgical, clinical decisions were relatively simpler and the “Heart Team” was smaller and more cohesive. However, with the introduction of catheter-based approaches in addition to surgery, specialties became more siloed. Today, with choices and treatments more complex than ever, it’s critical that we rekindle the Heart Team approach. Collective input and wisdom from a complement of medical, surgical and interventional experts is needed for optimal decision making.
This team approach, inclusive of shared-decision making with patients, is at the crux of patient-centered care. It is also the crux of a State-of-the-Art paper published on Feb. 25 in the JACC by myself and other cardiovascular and surgeon leaders. The paper highlights the many ways that managing care for patients with complex cardiovascular disease has changed substantially over the last decade with the advent of appropriate use criteria, advances in information technology, and an increasing amount of evidence-based data. As such, it points out that “failure to implement a Heart Team is increasingly not an option.”
Over the last three years, the Heart Team concept has been included as class 1 recommendations in European guidelines for coronary revascularization, as well as played a headlining role in the 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update, as well as the 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. In the case of coronary revascularization, AUC and Guidelines recommend that Heart Teams consist of cardiovascular surgeons, interventional cardiologists and primary cardiologists. More recently, in the case of transcatheter aortic valve replacement, Heart Teams will need to consist of surgeons, interventionalists, and general cardiologists, as well as imaging specialists, neurologists, cardiac anesthesiologists and others vital to patient selection and optimal procedural performance.
The paper highlights the balanced and complementary approach to patient care offered by the Heart Team as a result of joint and shared decision making among multi-disciplinary stakeholders. While specific strategies for implementation of Heart Teams will vary as a result of things like institutional structure or facility limitations, it is critical that the broad concept evolve to become the standard of cardiovascular care moving forward. “By exploring the multiple options available and sharing them with patients and their families where applicable, more optimal shared decision making is achieved, along with a tailored recommendation for therapy for a more informed and engaged patient,” the paper states. “From a professional team point of view, subsequent joint participation in procedures can not only improve the skill sets of all involved medical and surgical personnel but also elevate the cognitive interchange that occurs among the specialties.”
At the end of the day, dialogue among patients, their families and the various medical professionals involved in providing care is key to ensuring the most appropriate treatment. Ultimately our goal as physicians is to ensure our patients are not only equipped to take greater responsibility for managing their cardiovascular health, but to work collaboratively with us to achieve common goals. The Heart Team, in my mind, is the pathway to achieving this goal.
Read more about the Heart Team Approach on CardioSource.org.