Heart Team: Single Tertiary Centre Real World Experience

Abstract

Background: The primary reasons for referral included coronary artery disease, valvular heart disease, a combination of both, and cases with structural abnormalities. Treatment decisions varied, with a significant portion undergoing percutaneous coronary intervention or coronary artery bypass grafting surgery. The study underscores the importance of a structured multidisciplinary heart team in providing optimal care to cardiac patients, emphasizing the need for local implementation of such an approach to enhance patient outcomes. The objective is to share multidisciplinary heart team experience in a tertiary care hospital and discuss its structure and function for the management of cardiac patients.

Methodology: It is a Retrospective cross-sectional observational study conducted at the Peshawar Institute of Cardiology from 1st January 2021 to 31st December 2022. Both inpatient and outpatient referred consecutive patients with cardiovascular diseases were discussed in weekly multidisciplinary heart team meetings. Data was collected retrospectively for each patient from the coordinator and hospital management information system.

Results: A total number of 389 patients were discussed in 89 multidisciplinary heart team meetings over a period of two years. The mean age of patients was 58 ± 11.8 years, with 72.5% males and 27.5% females. Coronary artery disease was the most common reason for referral, i.e., 350 patients (89.97%), 17 (4.37%) patients had valvular heart disease, 08 (2.1%) had both coronary artery disease and valvular disease, and 14 (3.4%) were cases involving structural abnormalities. One hundred and forty-two (36.5%) patients decided to undergo percutaneous coronary intervention, 147 (37.7%) had coronary artery bypass grafting surgery decision, 17 (4.3%) patients were sent for valvular surgery, 08 (2.05%) patients were referred for both CABG and valvular surgery, and 15% had individualized percutaneous procedures or were deferred further procedures following non-invasive or invasive assessments.

Conclusion: A multidisciplinary heart team approach should be at the core of managing cardiac patients at an institute. In order to provide standard care to our patients, setting up a robust, structured multidisciplinary heart team and implementing its basic principles is possible at our local level.