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Page 6 of 16 Riojas et al. Vessel Plus 2024;8:6 https://dx.doi.org/10.20517/2574-1209.2023.122

present to the patient; and (5) employ feedback mechanisms [Figure 1]. These feedback mechanisms
include feedback to the patients and referring providers about the heart team recommendations, feedback to
the committee on overall guideline adherence and appropriate use criteria adherence, and long-term
feedback on overall outcomes. Using these and similar approaches, other multidisciplinary teams have
demonstrated decreased in-hospital costs, improved guideline adherence, improved interprofessional
communication, and reproducibility of consistency in decision making [27,41] .

As mentioned previously, the core heart team should include a cardiologist, a cardiac surgeon, and an
intensivist. Other members of the heart team may include primary cardiologists as well as interventional
cardiologists, cardiac anesthesiologists, referring providers, hospitalists, other specialists, and advanced
practice providers. Additional members may include ancillary staff such as clinical pharmacists,
[29]
nutritionists, social workers, and others as needed [Figure 2] . Typically, patients are presented in a
structured format and pertinent imaging is reviewed .
[19]
As with any project, there are several attributes that will lead to a successful heart team. The most successful
teams will develop enduring goals. Such goals and objectives should be achievable, realistic, and measurable.
A core team representative from cardiology and surgery should review and update the goals periodically. A
review of the heart team decisions and outcomes is imperative as part of a quality improvement (QI)
initiative. The QI initiative can be sponsored and evaluated by specific personnel trained in these
measurements. This initiative should follow a continuum, and as new evidence and guidelines are
published, the goals may need to be adjusted. A vital part of the heart team is uninhibited open
communication among the major stakeholders. There should be strong leadership and mutual respect
between team members. The atmosphere should maintain inclusivity and promote diversity and equity. It is
also paramount that there is full transparency of the outcomes. If there is concern about the conduct of the
team, goals, decisions, or outcomes, team members should feel at liberty to voice these concerns and a
timely response should be made by the core members. The team should strive to engage in continuing
education, employ new guidelines, and explore new treatment options. Of utmost importance, there should
be a goal of patient-centered decision making [35,42] . This may be challenging and care should be taken to
maintain HIPAA compliance. There should be an adequate facility or room with appropriate audiovisual
equipment and teleconferencing capabilities. Finally, there should be financial and administrative support
from the medical institution to promote the heart team. This may also include public verbal support,
providing appropriate expectations to participate, and respecting the time commitments of
stakeholders [5,9,17] .

BARRIERS TO A SUCCESSFUL HEART TEAM
Although all providers would agree to any measures that would improve patient care and outcomes, there
may be some barriers to the successful implementation of a heart team. One of the biggest hindrances may
be the culture at the institution. Some physicians at larger institutions may be burdened with multiple
meetings. There may be a lack of resources or space to hold a meeting. The various physicians may be at
different locations. By creating buy-in from multiple stakeholders, these cultural hurdles can be overcome.
While most heart team meetings had been face-to-face, one group showed that an online format was well
[43]
attended and very efficient, with a 98.7% completion rate of referrals . During the COVID-19 pandemic,
[44]
many conferences resorted to using teleconference media . Although the online format alleviated some of
the barriers to holding a meeting, the large increase in the number of virtual meetings also created a sense of
overwhelming time spent in teleconferences . This “Zoom fatigue” has been associated with anxiety,
[45]
feelings of social isolation, and emotional exhaustion . To mitigate some of these effects, the heart team
[46]
[47]
should aim to respect timely meetings, and equally reaffirm the value of efficient work and sociality .