Heart teams playing a major role in coronary revascularization decisions

While the value of collaboration is widely accepted, Rao said defining what constitutes a heart team remains a challenge. The American College of Cardiology (ACC) has outlined that core members of the heart team consists of a general cardiologist, a cardiac surgeon and an interventional cardiologist, but real-world implementation and team makeup varies widely across institutions. The goal of these teams to to select the best treatment option for patients between PCI and coronary artery bypass surgery.

At NYU Langone, Rao said the heart team structure formally incorporates patient preferences alongside input from multiple cardiovascular specialists. However, he acknowledged that replicating such a model can be difficult.

“Implementation of that is not so easy, particularly in a context of a center with a huge patient volume, trying to make decisions rapidly,” Rao said. 

He added that emerging technologies such as AI may help streamline the process.

Another ongoing concern is the time commitment required for heart team meetings, which often are not directly reimbursed. Rao said this remains a structural problem as healthcare systems transition toward value-based care.

“That is a challenge that we're going to have to deal with. As compensation models change, hopefully to incentivize more patient-centered care and quality metrics, I'm hopeful that this problem goes away,” Rao explained.

He also emphasized the need to reset patient expectations, particularly for those with complex coronary disease who may assume that diagnostic catheterization will automatically lead to PCI.

Rao noted that the heart team can be especially valuable in cases that fall into a clinical gray zone, where neither bypass surgery nor PCI is clearly superior, and when clinicians get overly aggressive with their choices.

“Just because you can do something doesn't mean that's the right thing to do,” Rao said.

Despite its inclusion as a class I recommendation in clinical guidelines, Rao thinks more evidence is needed to better define best practices for heart team implementation.

“There are no randomized data around it,” he said. “So I would really like to see more data to support the heart team because I think we're all doing it and I think we really need to know how best to do it and how best to implement it.”

Looking ahead, Rao believes cultural change within healthcare systems will continue to shape adoption of the heart team approach, particularly as consolidation and employment models reduce competition between specialties.

“We have to keep hammering home that the reason we're all in this is because we want to get the right treatment to the right patient at the right time,” Rao said. “It's really not about just generating RVUs for ourselves.”