Heart team approach points to mortality benefit in complex cardiac patients

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heart teamConsultation by a heart team led to an observed benefit in objective patient outcomes, a prospective analysis of patients treated at a single centre in Winnipeg, Canada has concluded.

The authors of the study, which was published in the American Journal of Cardiology, claim that theirs is the first such research to provide results of the mortality benefit of the heart team approach to patients. Joel A Scott-Herridge (University of Manitoba, Winnipeg, Canada) et al, add that they hope that this finding will translate into faster adoptation and greater use of heart team consultation within cardiac programmes, thereby improving patient care.

Scott-Herridge and colleagues note that the use of a team-based healthcare approach is a relatively recent development in the management of cardiovascular disease, with heart team consultation now a class I recommendation in guidelines from the American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC) for the management of patients with complex cardiac disease.

However, despite the class I guideline recommendation, the study team notes that there is a paucity of data to support whether this approach impacts patient outcomes. The study, therefore, set out to identify whether there is an objective benefit in using a heart team.

Researchers assessed patients aged 18 years or older who were reviewed by the heart team at their centre between 10 November 2013 and 15 May 2019, during which time 342 patients were enrolled. Cases required the presence of the referring cardiologist or surgeon, in addition to a heart team panel consisting of a general cardiologist, interventional cardiologist, cardiac surgeon, cardiac anaesthetist, intensive care unit physician and cardiac imaging technologist.

Each patient was followed to determine if the recommendations of the heart team were adhered to, with the patients’ medical records examined at 30 days and six months to monitor clinical outcomes including cardiac death, non-cardiac death, cerebrovascular accident, ST-segment elevation myocardial infarction (STEMI) and non-STEMI. The primary outcome was the relation between whether advice from the heart team was followed and cardiac death.

Of the 342 unique cases reviewed by the heart team, six were removed as a conclusion could not be reached. Among the 342 remaining cases, 287 were treated according to the heart team recommendation, whereas 49 were not. The researchers note that when analysing the differences between cardiac death in patients for whom the recommendations of the heart team were followed compared with those for whom they were not, cardiac death occurred less frequently at 6.3% vs. 15.3% (p=0.04).

Noting that they believe this is the first study to show a mortality benefit through adoption of the heart team approach, the researchers ascribe this to the presumption that improved outcomes were due to the ability to more accurately identify the most suitable therapeutic option via the team-based model.

However, Scott-Herridge et al note that the same differences were largely not observed within the secondary outcomes other than unanticipated cardiac hospital admissions and composite cardiac outcomes.

“Unanticipated cardiac hospitalisations were almost three times higher in patients in whom recommendations by the heart team were not followed compared with the patients in whom the recommendations were followed,” the researchers document in their paper.

Similarly, it is reported that the composite cardiac outcome was increased by two times in patients compared with those in whom recommendations by the heart team were not followed. “These differences cannot directly be attributed to a causal effect of the heart team because of the nature of this observational trial but are highly suggestive of the improved therapeutic plan provided by the heart team,” Scott-Herridge et al add.

Despite pointing towards a mortality benefit achieved through use of the heart team strategy, the study’s authors note that their research is limited by its design, and to unequivocally determine if the heart team is the cause for the positive results would require a randomised clinical trial.


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