Teamwork and Speed Bumps

Heart Teams have come to occupy a prominent place in modern cardiovascular disease. While the concept is intuitively obvious - bringing together specialties of diverse backgrounds to focus on care of the individual patient - they have been harder to actually implement in clinical practice and it has been difficult to define metrics of success. One documented metric has been the design, implementation, and end result of randomized clinical trials that were conducted with co-investigators of both interventional cardiology and cardiovascular surgery which resulted in pivotal presentations of outcomes in specific patient groups. This metric, however, has come under scrutiny because of trial performance, conclusions, and implications for practice. The resulting controversies should not result in retreat from the concept of the Heart Team which should be at the heart of optimizing care for individual patients based upon scientific evidence and expert consensus on the issues of optimal cardiovascular care. The widespread use of telemedicine can play a major role in enhancing decision making by the Heart Team. Abbreviations: IC: Interventional Cardiology; CVS: Cardiovascular Surgery; CABG: Coronary artery bypass grafting; PCI: Percutaneous coronary intervention; CAD: Coronary artery disease; TAVR: Transcatheter aortic valve replacement; SAVR: Surgical aortic valve replacement; RCTs: Randomized clinical trials; CMS: Centers for Medicare and Medicaid Services; FDA: Food and Drug Administration.