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Mazza A, Iafrancesco M, Bruno P, Chiariello GA, Trani C, Burzotta F, Cammertoni F, Pasquini A, Diana G, Rosenhek R, Liuzzo G, Rabini A, Flex A, Raweh A, Crea F, Massetti M. The multidisciplinary Heart Team approach for patients with cardiovascular disease: a step towards personalized medicine. J Cardiovasc Med (Hagerstown) 2023; 24:906-913. [PMID: 37577876 DOI: 10.2459/jcm.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
AIMS Despite general agreement on the benefits of the Heart Team approach for patients with cardiac diseases, few data are available on its real impact on the decision-making process. The aim of the study is to define the evolution over time of the level of agreement with the systematic discussion of patients in the Heart Team and to evaluate the adherence to the Heart Team recommendations and the impact of the Heart Team on the clinical outcome of the patients. METHODS In 2015--2016, an experienced cardiac surgeon and a cardiologist independently reviewed clinical data of a series of 100 patients (Group 1, G1) and subsequently for each patient recommended treatment (surgical, percutaneous, hybrid or medical therapy) or further diagnostic investigations. The next day, each case was discussed by the Hospital Heart Team. The Heart Team recommendation, the subsequent treatment received by the patient and the in-hospital outcome were recorded. The same study procedure was repeated in 2017 in a second (G2) and in 2018 in a third (G3) group, both of them including 100 patients. RESULTS Complete agreement in treatment selection by the cardiac surgeon, cardiologist and the Heart Team was observed in 43% of cases in G1 and in 70% and 68% in G2 and G3, respectively (G1 vs. G2: P < 0.001, G1 vs. G3: P = 0.01, G2 vs. G3: P = 0.30). Agreement was less frequent in patients with a higher risk profile and in patients with aortic valve stenosis. The Heart Team decision was implemented in 95% of cases with a 30-day mortality of 0.67%. CONCLUSION Agreement in treatment selection among the cardiac surgeon, cardiologist and Heart Team appears to be low in the initial experience. Subsequently, it seems to steadily increase over time up to a limit, when it reaches a plateau of stable results. Heart Team clinical cases discussion, based on both guidelines and multidisciplinary experience, represents a key step in defining the best patient treatment pathway, potentially improving the decision-making process and clinical results.
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Affiliation(s)
- Andrea Mazza
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Mauro Iafrancesco
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Giovanni Alfonso Chiariello
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Carlo Trani
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Federico Cammertoni
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Annalisa Pasquini
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Giovanni Diana
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Raphael Rosenhek
- Catholic University of The Sacred Heart, Rome, Italy
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Giovanna Liuzzo
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Alessia Rabini
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Andrea Flex
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Abdallah Raweh
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Filippo Crea
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
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Jonik S, Marchel M, Huczek Z, Kochman J, Wilimski R, Kuśmierczyk M, Grabowski M, Opolski G, Mazurek T. An Individualized Approach of Multidisciplinary Heart Team for Myocardial Revascularization and Valvular Heart Disease—State of Art. J Pers Med 2022; 12:jpm12050705. [PMID: 35629130 PMCID: PMC9144508 DOI: 10.3390/jpm12050705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
The multidisciplinary Heart Team (HT) remains the standard of care for highly-burdened patients with coronary artery disease (CAD) and valvular heart disease (VHD) and is widely adopted in the medical community and supported by European and American guidelines. An approach of highly-experienced specialists, taking into account numerous clinical factors, risk assessment, long-term prognosis and patients preferences seems to be the most rational option for individuals with. Some studies suggest that HT management may positively impact adherence to current recommendations and encourage the incorporation of patient preferences through the use of shared-decision making. Evidence from randomized-controlled trials are scarce and we still have to satisfy with observational studies. Furthermore, we still do not know how HT should cooperate, what goals are desired and most importantly, how HT decisions affect long-term outcomes and patient’s satisfaction. This review aimed to comprehensively discuss the available evidence establishing the role of HT for providing optimal care for patients with CAD and VHD. We believe that the need for research to recognize the HT definition and range of its functioning is an important issue for further exploration. Improved techniques of interventional cardiology, minimally-invasive surgeries and new drugs determine future perspectives of HT conceptualization, but also add new issues to the complexity of HT cooperation. Regardless of which direction HT has evolved, its concept should be continued and refined to improve healthcare standards.
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Affiliation(s)
- Szymon Jonik
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
- Correspondence: ; Tel.: +48-22-599-19-58; Fax: +48-22-599-19-57
| | - Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (R.W.); (M.K.)
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (R.W.); (M.K.)
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Tomasz Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
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