TY - JOUR
T1 - The rationale for heart team decision-making for patients with stable, complex coronary artery disease
AU - Head, Stuart J.
AU - Kaul, Sanjay
AU - MacK, Michael J.
AU - Serruys, Patrick W.
AU - Taggart, David P.
AU - Holmes, David R.
AU - Leon, Martin B.
AU - Marco, Jean
AU - Bogers, Ad J.J.C.
AU - Kappetein, A. Pieter
PY - 2013/8/21
Y1 - 2013/8/21
N2 - Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called 'Heart Team' concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable complex coronary artery disease. In addition, other aspects of Heart Team decision-making are discussed: the organization and logistics, involvement of physicians, patients, and assisting personnel, the need for validation, and its limitations.
AB - Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called 'Heart Team' concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable complex coronary artery disease. In addition, other aspects of Heart Team decision-making are discussed: the organization and logistics, involvement of physicians, patients, and assisting personnel, the need for validation, and its limitations.
KW - Appropriateness
KW - Coronary artery bypass grafting
KW - Guidelines
KW - Heart Team
KW - Multidisciplinary
KW - Percutaneous coronary intervention
KW - Revascularization
KW - Shared decision-making
KW - Underuse
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U2 - 10.1093/eurheartj/eht059
DO - 10.1093/eurheartj/eht059
M3 - Review article
C2 - 23425523
AN - SCOPUS:84881093431
SN - 0195-668X
VL - 34
SP - 2510-2518b
JO - European heart journal
JF - European heart journal
IS - 32
ER -