‘Heart Team’ Concept – A reality or a ‘Platonic Illusion’

Yadava, Om Prakash

doi:10.1016/j.ihj.2017.02.005

Cited by 11 publications

(17 citation statements)

References 5 publications

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“…Potentially professional and institutional interests drive the indication for a surgical or a catheter intervention [15,16]. Some view the heart team as an institutional illusion to cover conflicts of interests [17]. The critics were served by a recent BBC broadcast on the EXCEL trial and professional differences of opinion between cardiac surgeons and cardiologists about the best treatment of left main coronary artery disease [18].…”

Section: The Heart Team-definitions and Rolesmentioning

confidence: 99%

Heart teams in the Netherlands: From teamwork to data‑driven decision-making

Wierda¹,

Veghel

Hirsch

et al. 2020

Neth Heart J

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For all patients with cardiovascular disease requiring an intervention, this is a major life event. The heart team concept is one of the most exciting and effective team modalities to ensure cost-effective application of invasive cardiovascular care. It optimises patient selection in a complex decision-making process and identifies risk/benefit ratios of different interventions. Informed consent and patient safety should be at the centre of these decisions. To deal with increased load of medical data in the future, artificial intelligence could enable objective and effective interpretation of medical imaging and decision support. This technical support is indispensable to meet current patient and societal demands for informed consent, shared decision-making, outcome improvement and safety. The heart team should be restructured with clear leadership, accountability, and process and outcome measurement of interventions. In this way, the heart team concept in the Netherlands will be ready for the future.

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Section: The Heart Team-definitions and Rolesmentioning

confidence: 99%

Heart teams in the Netherlands: From teamwork to data‑driven decision-making

Wierda¹,

Veghel

Hirsch

et al. 2020

Neth Heart J

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“…Without it, decisions regarding surgery vs. transcatheter management were likely to be influenced, in part, on which specialist the patient sees first. 1 In the current era of evidence-based practice when patient-centered care is becoming the norm, the Heart-Team approach has become an integral part of care and has received Class I recommendations in the 2017 editions of both the AHA/ACC Focused Update of the 2014 Guideline for the Management of Patients with Valvular Heart Disease and the ESC/EACTS Guidelines for the management of valvular heart disease. 2,3 The Heart-Team plays a central role in the patient care process, from adequate patient selection and procedural planning to improved patient education and follow-up care.…”

Section: Introductionmentioning

confidence: 99%

Changes in Outcomes Over Time in Intermediate-Risk Patients Treated for Severe Aortic Stenosis

Khalil¹,

Boukhris

Badreddine³

et al. 2020

Preprint

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Background:The advent of TAVR changed the practice for treating patients with severe aortic stenosis. Heart-Teams improved their decision-making process to refer patients to the best and safest treatment. Evidence allowed centers to increase funding and TAVR volume and extend indications to different risk category of patients. This study evaluates the outcomes of intermediaterisk patients treated for severe aortic stenosis in an academic center. Methods:Between 2012 and 2019, 812 patients with aortic stenosis underwent TAVR or SAVR. A propensity score-matching analytic strategy was used to balance groups and adjust for time periods. Outcomes were recorded according to the Society of Thoracic Surgeons Guidelines; primary outcome being 30-day mortality and secondary outcomes being perioperative course and complications. Results:No difference in mortality was seen but complications differed: more postoperative transient ischemic attacks, permanent pacemaker implantations and perivalvular leaks in the transcatheter group, while more acute kidney injuries, atrial fibrillation, delirium, postoperative infections and bleeding, tamponade and need for reoperation in the surgical group as well as longer hospital length-of-stay. However, over the years, morbidities/mortality decreased for all patients treated for aortic stenosis. Conclusions:Data showed an improvement in morbidities/mortality for intermediate risk patients treated with SAVR or TAVR. Increased funding allowed for higher TAVR volume by increasing access to this technology. Also, the difference in complications could impact healthcare cost. By incorporating important metrics such as length-of-stay, readmission rates and complications into decision-making, the Heart-Team can improve clinical outcomes, healthcare economics and resource utilization.

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“…At the same time, there are contrary opinions regarding the utility of the Heart Teams: "as it stands today, "Heart Team" is more of a fictional euphemism, a kind of 'Platonic Illusion' rather than a pragmatic reality." [56] e future studies though should provide solid financial arguments and better survival rates in order to both sustain its complex decisions and justify its financial support. ere is a need for new studies investigating the significance of delays in the decision-making process of Heart Team as well as financial aspects regarding its gatherings (healthcare providers reimburse Heart Teams for its decisions-in which inappropriate coronary revascularisations are lowered and outcomes are improved) [1].…”

Section: Cardiovascular Erapeuticsmentioning

confidence: 99%

Exploring Current Evidence on the Past, the Present, and the Future of the Heart Team: A Narrative Review

Burlacu

Covic

Cintezǎ

et al. 2020

Cardiovascular Therapeutics

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Introduction. Including healthcare professionals dealing with cardiovascular diseases, Heart Team is a concept/structure designed for selecting diagnostic strategies, facilitating therapeutic decisions, and improving cardiovascular outcomes in patients with complex heart pathologies, requiring input from different subspecialties and the necessity of a multidisciplinary approach. The aim of this narrative review is to search for and to summarize current evidence regarding Heart Team and to underline the future directions for the development of this concept. Methods. We searched the electronic database of PubMed, SCOPUS, and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies were included, if reference was made to Heart Team structure and functionality. Results. We depicted the structure and the timeline of Heart Team, along with actual evidence-based recommendations from European Guidelines. We underlined the importance of quality of knowledge-sharing and decision-making inside the Team, analyzing bad decisions which did not reflect members’ true beliefs due to “uniformity pressure, closed mindedness, and illusion of invulnerability.” The observation that Guidelines’ indications regarding Heart Team carry a level C indication underlines the very future of this Team: randomized controlled trials proving solid benefits in an evidence-based world. Conclusions. Envisioned as a tool for optimizing the management of various complex cardiovascular pathologies, Heart Team should simplify and facilitate the activity in the cardiovascular ward. Finally, these facts should be translated into better cardiovascular outcomes and a lower psychological distress among Team participants. Despite all future changes, there must always be a constant part: the patient should remain at the very center of the Team.

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‘Heart Team’ Concept – A reality or a ‘Platonic Illusion’

Cited by 11 publications

References 5 publications

Heart teams in the Netherlands: From teamwork to data‑driven decision-making

Heart teams in the Netherlands: From teamwork to data‑driven decision-making

Changes in Outcomes Over Time in Intermediate-Risk Patients Treated for Severe Aortic Stenosis

Exploring Current Evidence on the Past, the Present, and the Future of the Heart Team: A Narrative Review

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