title: Heart team discussion in managing patients with coronary artery disease: outcome and reproducibility.
abstract: Recent ESC/EACTS revascularization guidelines advocate a 'Heart Team' (HT) approach in the decision-making process when managing patients with coronary disease. We prospectively assessed HT decision-making in 150 patients analysing personnel attendance, data presented, the 'actioning' of the HT decision and, if not completed, then the reasons why. Additionally, 50 patients were specifically re-discussed after 1 year in order to assess consistency in decision-making. We have two HT meetings each week. At least one surgeon, interventional cardiologist and non-interventional cardiologist were present at all meetings. Data presented included patient demographics, symptoms, co-morbidities, coronary angiography, left ventricular function and other relevant investigations, e.g. echocardiograms. HT decisions included continued medical treatment (22%), percutaneous coronary intervention (PCI; 22%), coronary-artery bypass grafting (CABG; 34%) or further investigations such as pressure wire studies, dobutamine stress echo or cardiac magnetic resonance imaging (22%). These decisions were fully undertaken in 86% of patients. Reasons for aberration in the remaining 21 patients included patient refusal (CABG 29%, PCI 10%) and further co-morbidities (28%). On re-discussion of the same patient data (n = 50) a year later, 24% of decisions differed from the original HT recommendations reflecting the fact that, for certain coronary artery disease pattern, either CABG or PCI could be appropriate.
authors.affiliation: Cardiothoracic Unit,  Heart & Lung Centre, New Cross Hospital, Wolverhampton,  UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Long
authors.forename: Heyman
authors.initials: H
authors.lastname: Luckraz
authors.forename: Joyce
authors.initials: J
authors.lastname: Thekkudan
authors.forename: Abdul
authors.initials: A
authors.lastname: Maher
authors.forename: Michael
authors.initials: M
authors.lastname: Norell
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D004739:England; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents