Heart Team consultations lead to better patient outcomes, fewer unexpected hospitalizations
Consulting with a multidisciplinary heart team (HT) is associated with improved clinical outcomes and fewer unexpected cardiac hospitalizations, according to a new study published in the American Journal of Cardiology.[1]
“Consultation by a HT is now a level I recommendation by the European Society of Cardiology and the American College of Cardiology/American Heart Association in the management of patients with complex cardiac disease including but not limited to coronary artery disease and valvular heart disease,” wrote lead author Joel A. Scott-Herridge, MD, a cardiologist with the University of Manitoba in Canada, and colleagues. “Despite the assumed advantages of the HT approach over decision making by the individual physician and the level I recommendations, the HT approach has still not been widely adopted. The purpose of this study was to identify whether there was an objective benefit in using the HT approach.”
The group evaluated data from 342 adult patients treated at a single facility from November 2013 to May 2019. While median age was 66.3 years old, 70.4% of patients were men.
Patients were referred to this study based on the discretion of the patient’s attending physician or surgeon. The heart team in question included the referring physician or surgeon, in addition to a general cardiologist, interventional cardiologist, cardiac surgeon, cardiac anesthetist, ICU physician and cardiac imaging technologist. A separate consultation focused on structural heart issues would then occur if necessary.
“There was no script because each case had unique features, making the discussions different for every case,” the authors wrote. “On completion of a detailed discussion, looking at the patient as a whole, their ability to tolerate anesthesia, their predicted ICU course and also considering medical alternatives, a conservative approach and palliation, the HT panel would provide its recommendation.”
Heart teams often offer different recommendations over the original care plan
Overall, the heart team’s recommendations were different than the referring physician or surgeon’s initial recommendation in 54% of cases. Recommendations made by the HT were followed in 83.8% of cases. When these recommendations were followed, the authors noted a “significant reduction” in cardiac mortality (6.3% vs. 15.3%) and the composite outcome that included cardiac mortality, cerebrovascular accident, dialysis, NSTEMI, STEMI or cardiac hospitalization (23.4% vs. 51.9%).
In addition, unanticipated cardiac hospitalizations were nearly three times as likely when clinicians did not follow HT recommendations.
“These differences cannot directly be attributed to a causal effect of the HT because of the nature of this observational trial but are highly suggestive of the improved therapeutic plan provided by the HT,” the authors wrote.
The team also noted that there were certain limitations involved with their analysis, including the small percentage of patients presenting with cardiac disease who were actually included. Also, since there were many cases where the HT and referring physician or surgeon were on the same page when it came to treatment decisions, it is hard to say consulting with the heart team made any impact.
Even with these limitations in mind, however, the authors hope their work can “translate to faster adaptation and greater use of the HT by cardiac programs, thereby improving patient care.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.